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Parent/Guardian
Field Trip/Activity
Permission Form
Name of School/Org: Brighton High School Robotics Team
I hereby give may consent for __________________________________________________________________
Student Name
to accompany their teammates on a trip to participate in
Bloomfield Girls Robotics Competition located at Bloomfield Hills High School in the city of Bloomfield Hills on the dates of Oct 14, Oct 15
and understand that they will be transported by a Private Vehicle.
Authorization and Release for a Passenger in a Vehicle
I give my permission for my child to be a passenger in a vehicle driven by a Coach or School Approved Mentor.
_____________________________________________________________ __________________
Parent or Legal Guardian Signature Date
Emergency Information
______________________________ ______________________________ ______________________________
Home Phone Cell Phone Work Phone
________________________________________ _____________________________________________________
Name of Insurance Carrier Family Physician Name and Phone Number
Medication that must accompany the child and information that you wish to share (ie. allerigies, medications, medical conditions, etc):
______________________________________________________________________________________________________
Authorization and Release for Medical Care
I authorize Brighton Area Schools, its employees, designees, or sponsors in attendance at any Brighton Area Schools or Robotics Team event to secure, select and consent to necessary medical attention for may child resulting from injury, illness or accident requiring medical care while I am not in attendance.
I release the Brighton Area Schools and such person(s) from any liability for the selection in securing of a medical provider.
_____________________________________________________________ __________________
Parent or Legal Guardian Signature Date