Last Name: _____________________

Kern High School District

PARENT CONSENT FOR FIELD TRIP
AND
MEDICAL AUTHORIZATION

To the Principal of GOLDEN VALLEY HIGH SCHOOL: _________________________________

has my permission to participate in : (student name)

ALL BAND, COLORGUARD, DRUMLINE ACTIVITIES/FIELD TRIPS

These include home and away game performances, local and out-of-town competitions, festivals,
parades, fund-raisers, and any additional trips sanctioned by Golden Valley High School.

METHOD OF TRANSPORTATION: District, school, and private vehicles driven by approved,

licensed adults over 21 years of age.

This field trip is made pursuant to the provisions of California State Education Code Sections 35350
and 35330. These sections provide in part that “all persons making the field trip are deemed to have
waived all claims against the Kern High School District and its employees, the Kern County
Superintendent of Schools and the State of California for injury, accident, illness, or death occurring
during or by reason of this field trip.”

I agree to direct my child to cooperate and conform with directions and instructions of the school
district personnel in charge of the activity.

____________________________________________ _______________
Signature of Approval by Parent or Guardian Date

_______________________________________ MEDICAL AUTHORIZATION

Student Name
________________________________ ____________
Should it be necessary for my child to have medical treat- Parent/Guardian Signature Date
ment while participating in this trip/activity, I hereby give
the school district personnel permission to use their judge- ________________________________________________
ment in obtaining medical service for the child, and I give Address Zip
permission to the physician selected by the school district __________________ ________________
personnel to render medical treatment deemed necessary Home Phone Business Phone
and appropriate by the physician. __________________
Emergency Phone

____ Please check here if special instructions regarding medical treatment of any kind are required. List below: