VISITATION SCHOOL FAN BUS & STUDENT ACTIVITY PERMISSION AND RELEASE FORM
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I. STUDENT INFORMATION
Student Full Name and Address *
Student Date of Birth *
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Students must carry their emergency medications (Epi pen, inhaler, etc) with them. Please state any of your child's medical or physical conditions which will help ensure his/her safety.  Write "None," if there are none: *
II. PARENTAL RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT As a custodial parent or legal guardian (the “Parent”) of____________________________________  (please print student’s full name) (the “Child”), in consideration of my Child being permitted to  participate in this student activity (collectively referred to as the “Activity”), I hereby release, waive and  forever discharge Visitation School (the “School”), its trustees, officers, employees, agents and assigns of  and from any and all claims and liabilities, including but not limited to negligence claims, that may arise  from my Child’s participation in the Activity. I will not sue or bring any such claims, on my own behalf or  on behalf of my Child, in connection with any death, injury, accident, illness or other damages or losses  suffered by my Child. This release includes but is not limited to claims for any harm suffered by my Child  if she/he was not following or obeying any rules or guidelines of the School, chaperone, or for the Activity.  I hereby agree to indemnify the School, its trustees, officers, employees, agents and assigns from and against any and all claims, suits, actions, causes of action, and liabilities, including attorneys’ fees,  resulting directly or indirectly from my Child’s participation in the Activity, including but not limited to  injury of any person caused by my Child or for damages to or destruction of any property caused by my  Child. I have reviewed all information relating to the Activity and recognize and appreciate the risks and  dangers associated with my Child’s participation in the Activity, including but not limited to risks  associated with travel and participating in the daily activities of the Activity. I hereby assume the risk  of any and all losses and damages, including but not limited to personal injury, which my Child may incur  as a result of participating in the Activity.I recognize that general social and political conditions and circumstances may affect the Activity and are  outside the School’s control. I agree, with knowledge of those conditions and circumstances, to allow my  Child to participate in the Activity and to assume the risks that I am assuming by this agreement. *
III. PARENTAL PERMISSION TO PARTICIPATE I understand that my Child’s participation in this Activity is voluntary. By signing this form, I certify that  my Child is physically and emotionally able to fully participate in this Activity. I acknowledge that I have  had the opportunity to ask questions and obtain whatever information I require to inform myself about  the Activity. I am satisfied as to the adequacy and safety of the arrangements made by the School for the Activity.
STUDENT ACTIVITY:   State Swim/Dive Fan Bus
DATE:   Friday, November 17, 2023
LOCATION:   University of Minnesota Aquatic Center
TRANSPORTATION:   Chartered Fan Bus
SPECIAL INSTRUCTIONS:   The fan bus will depart from Visitation at 11:30a.m. to go to the meet and will depart from the U of M Aquatic Center to return to Visitation at approximately 15 minutes after the awards ceremony.  Students taking the Fan Bus are required to ride it both to and from the matches - no exceptions.  Seating is limited to one bus and is available on a first come/first served basis.
 
PLEASE SUBMIT THIS FORM ELECTRONICALLY BY THE END OF THE SCHOOL DAY ON THURSDAY, NOVEMBER 16, 2023
As the custodial parent(s) or legal guardian(s) of _______________________________________  (please print student’s full name), I hereby give my consent to my Child to participate in the Activity.  This consent is given freely and voluntarily with full knowledge of the inherent dangers involved. I  have read and understand the terms and conditions of this release and I voluntarily agree to the terms  above. *
PARENT/GUARDIAN NAME: *
PARENT/GUARDIAN E-SIGNATURE: This electronic signature and its related fields replaces a handwritten signature on paper and is legally binding. *
E-SIGNATURE DATE FOR PARENT/GUARDIAN *
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STUDENT NAME: *
STUDENT E-SIGNATURE:  If the student will be over age 18 at any time prior to or during the Activity, the student must also  sign. I will be 18 years of age prior to or during the Activity. I am voluntarily participating in the Activity with full knowledge of the inherent dangers involved. I have read and understand the terms and  conditions of this release and I voluntarily agree to the terms above. This electronic signature and its related fields replaces a handwritten signature on paper and is legally binding. *
E-SIGNATURE DATE FOR STUDENT *
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