Title
Annual Field Permission Form
By completing this form your student will be able to participate in any and all fieldwork activities conducted at the following locations: Stokes Nature Center, Utah State University, Bridgerland Technical College (BATC), local public and private schools, local government buildings or facilities, parks and businesses located throughout Cache Valley. I understand that for activities entering bodies of water such as kayaking, swimming, as well as traveling outside of Cache Valley, or participating in other field work experiences with a higher accident risk—an additional individual permission slip will be required for participation. Notifications for additional permission slips will be provided through classroom newsletters, Canvas, email, or phone messages and will be housed in the class forms area of PowerSchool. When applicable, a lunch count will be requested in advance to ensure adequate meal planning for fieldwork days.
The undersigned, the legal guardian of the student in this form (hereinafter “student”) a student at The Center for Creativity, Innovation and Discovery, ("CCID") under eighteen years of age, in consideration of student’s participation in the above stated field work do hereby agree to this waiver and release. I recognize that participation in the above stated field work may involve moderate to strenuous physical activity and may cause physical and or emotional distress to participants. There may also be associated health risks. I state that the student is free from any known heart, respiratory or other health problems that could prevent my student from safely participating in any of the activities. I certify that I have medical insurance or otherwise agree to be personally responsible for costs of any emergency or other medical care that student receives. I agree to release the State of Utah, CCID, and their agencies, departments, officers, employees, agents, and all sponsors, officials and staff or volunteers from the cost of any medical care that student receives as a result of participation in the above stated field work. I further agree to release the State of Utah, CCID, their agencies, departments, officers, employees, agents and all sponsors, officials and staff or volunteers from any and all liability, claims, demands, breach of warranty, negligence, actions, and causes of actions whatsoever for any loss, claim, damage, injury, illness, attorney’s fees or harm of any kind or nature to me arising out of student’s participation in this CCID course/program. This release extends to any claim made by parents or guardians or their assigns arising from or in any way connected with the aforementioned activities. CONSENT Consent is expressly given, in the event of injury, for any emergency aid, anesthesia and / or operation, if in the opinion of the attending physician, such treatment is necessary. I have carefully read and understand the contents of the foregoing language and I specifically intend it to cover student’s participation in the above stated field work.
