Totino-Grace High School

Activity/Athletic Overnight Trip

Permission Form I request that Totino-Grace High School allow my son/daughter_______________________ to participate in the Cross Country Camping Trip to St. Croix State Park being held in Hinckley, MN. 8/15/16 1:30 p.m. 8/18/16 Approx. 12:00 p.m. and give permission for him/her to take part in all activities associated with the trip. I further understand that transportation will be provided by: Bus . In consideration for my child’s participation in this activity I agree to hold blameless the school and its faculty and staff for any accident or injury which may occur during this trip. I also agree that all school rules are in force for the duration of the trip. Parent or Guardian Authorization: If I cannot be reached in an emergency, I hereby consent for a qualified physician or surgeon to examine, diagnose and to prescribe or perform treatment, including surgery, that is deemed advisable for the welfare of the above named participant. Parent/Guardian Signature: _________________________________________________ Parent Emergency Names/Phone Number(s):_________________________________ _____________________________________________________________________________ In case Parent/Guardian cannot be reached Second Emergency contact:

Name: ______________________________________________________________________ Phone Number(s): ___________________________________________________________

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