I, the parent or guardian of

Student's First Name*

First

Student's Last Name*

Last

Date of Birth*

Grade*

give permission for the student to participate in Event/Trip/Dance.

Name of Event/Trip/Dance*

Location of Event/Trip/Dance*

Date of Event/Trip/Dance*

All information concerning the Event/Trip/Dance, including the date of the trip, meals, money, transportation, as well as departure and arrival time has been provided to me.*

YES
NO

I agree to the Event/Trip/Dance itinerary and rules.*

YES
NO

We understand and agree that if in the judgment of the representatives of the school the student endangers himself of any other Participant, engages in any activity that lowers the reputation of Devon Preparatory School or otherwise presents a problem, he will be subject to the disciplinary actions set forth below. We understand and agree that any and all luggage and personal effects including items purchased by the Student may be subject to inspection at any time, as well as prior to departure, at the discretion of the representatives of the school. Any harmful or dangerous items found during such inspection may be confiscated. Any Student related to such items will also be subject to the disciplinary actions set forth below. We understand and agree that the Student’s possession or use of alcohol, or the Student’s possession or use of drugs other than the medications set forth on the Health Information form will subject the student to the disciplinary actions set forth below. Violation of the norms of conduct set forth above may result in disciplinary actions as described in the current Devon Preparatory School Handbook. If necessary, a Disciplinary Committee will be convened. Disciplinary actions may include but are not limited to the Student being sent home from the Event/Trip/Dance at my expense and may also result in his expulsion from Devon Preparatory School or other appropriate disciplinary action. Devon Preparatory School also reserves the right to place a record of disciplinary infractions and consequences imposed on the Student in the Student’s permanent record which may be disclosed to institutions of higher learning and future employers. The terms and conditions of the Devon Preparatory School Handbook are incorporated herein by reference. We understand and agree that any fees paid are non-refundable. The undersigned on our behalf and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE Devon Preparatory School, Field Trip Supervisors, Faculty, Administration and the Piarist Fathers (“Releasees”), with respect to any and all injury, disability, death, loss or damage to person or property incident to the Event/Trip/Dance and associated activities, whether arising from the negligence of the Releasees or otherwise, to the fullest extent permitted by law.

Date*

Parent / Guardian Email

Signature of Parent / Guardian*

Date*

Signature of Student*

Consent for Emergency Medical Treatment

I, (Parent / Guardian please print your name below)*

the*

Father
Mother
Legal Guardian

of (please write student's name below)*

hereby consent to and authorize the performance of (Student) treatment deemed advisable by the appropriate medical personnel in attendance, including but not limited to diagnostic tests, surgery, and administration of anesthetics.

Date*

Signature of Parent / Guardian*

Name

This field is for validation purposes and should be left unchanged.

Agreement and Release Form

Agreement and Release

Consent for Emergency Medical Treatment