General Trip Permission

Child's Name (Last, First MI)

Parent/Guardian Name

This address will receive a confirmation email

Phone

By filling out this form, I grant permission for my child to participate in Religious Education (R.E.) field trips and to be transported in the personal car of an adult driver while participating in this activity. I agree to hold harmless and blameless Bellingham Unitarian Fellowship (BUF), its employees, and all adult chaperones from any and all liability from damages, loss, or injuries, either to person or property, which my child may sustain while engaged in this field trip, including, but not limited to transportation. Should any injury occur, I grant permission to the supervising adult to authorize necessary medical services, including injections, anesthesia, surgery, and medication, if I cannot be contacted at the telephone numbers shown above. I agree to be responsible for any expenses not covered by my insurance that may be incurred as a result of an accident or medical emergency involving the above-named child.

Yes No

Insurance Information

Health Insurance Provider

Group ID

Policy Number

Subscriber Name

Employer

Doctor Name and Phone Number

Emergency Contact Name and Phone Number

Special Health Concern or Food Allergy

Field Trip Driver Information

Driver Name

Vehicle Make and Model

Insurance Carrier

Policy Number

Safe Church Policy

BUF and the RE program welcome all children and youth and their families. We encourage all members of the congregation to volunteer with the children and youth as they are willing and able. Because we value the special circle of trust that we have created here, we require all adult volunteers who work with children and youth to consent for criminal background check and sign a code of ethics. We accept the responsibility to educate ourselves and our children about sexual misconduct, abuse, molestation, harassment and exploitation. We pledge to conduct ourselves in a manner that conveys mutual respect. If you have any questions about this, please contact Jennifer Smith, Director of Lifelong Learning.Awaiting Text...

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General Trip Permission

Description

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