Villa Visit Permission Slip

			Please print, LAST NAME first

 

HIGH SCHOOL

10656 Anderson Street

Loma Linda, CA 92354

Telephone (909) 796-0161

Christian Mission Class Field Trips to the Villa

May 2, 9, 23, 30 2018

Leave LLA: 11:00 a.m.                     Return to LLA: 12:15 p.m.

===========================================================================

PERMISSION SLIP

I hereby give permission for my son or daughter ____________________________________________

                         Student’s Name

to attend the Christian Mission class field trips to the Loma Linda Villa on May 2, 9, 23, 30 2018.  These trips are part of the service project to connect with an elderly resident at the villa over four visits.

                                               

                                                                                    ______________________________________

Parent’s Signature

===========================================================================

In the event of sudden illness or accident requiring attention, I hereby authorize Loma Linda Academy to administer first aid, and if necessary, take my child for emergency treatment to any qualified emergency care center.

Please list any special medical needs: ______________________________________________________        

I approve the following to be administered to my child on an as needed basis:  All _____    None _____    Only those checked _____

Tylenol                    Advil                       Sudafed                   Tums                       Benadryl                  Robitussin cough syrup

______________________________________

                                                                                    Parent’s Signature

===========================================================================

RELEASE

I agree to indemnify and hold harmless the sponsors, Loma Linda Academy and Southeastern California Conference and Association of Seventh-day Adventists, for liability arising from any accident or injury occurring during the Christian Mission field trip to the Loma Linda Villa May 2, 9, 23, 30 2018. This specifically includes injury arising from negligence on the part of those mentioned above. This recognizes a shared responsibility between school, student and home. This does not include gross negligence on the part of those mentioned above. This does not waive coverage within the policy limits of student accident insurance which covers school sponsored activities.

                                                                        ___________________________________   

Student’s Signature & Date                            Parent’s Signature & Date

                                                                        ___________________________________           

Print Student's Name                                      Print Parent’s Name

                                                                        ___________________________________

Student’s Cellular Number                             Parent’s Cellular Number