EXCURSION/FIELD TRIP WAIVER AND MEDICAL AUTHORIZATION
Date: November 22, 2019
I hereby give my permission for my child and/or myself, to participate in the Bionerds field trip or excursion* as a part of Bionerds Programs specified below:
I fully understand that my child is to accept all rules and requirements governing conduct during the field trip. It is understood that any child determined to be in violation, or unfulfilling of this behavior standard will be sent home at the parents' or guardians' expense. Parent or guardian has to be ready to pick up the child anytime during the field trip.
I, the undersigned, hereby release and discharge Bionerds, its members and employees (herein collectively referred to as "Company") from all liability arising out of or in connection with the above-described field trip or excursion. For the purposes of this agreement, liability means all claims, demands, losses, causes of action, suits, or judgments of any and every kind that I, my heirs, executors, administrators or assignees may have against the Company because of any death, personal injury or illness, or because of any loss or damage to property that occurs during the above described field trip or excursion and that results from any cause other than the negligence of the Company.
In the event of any illness or injury, I hereby consent to whatever X-ray, examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care from a licensed physician and/or surgeon as deemed necessary for the safety and welfare of my child. It is understood that the resulting expenses will be the responsibility of the parent(s) or guardian(s) or participant.
List any allergy if any: