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Parental Consent Form

Acknowledgment of Risk and Consent for Treatment for Minor Participants in Event or Field Trip
  • Class/department: Education Studies
    Field trip leader: Professor Rob Linné, 516.877.4411
    Field trip destination: Adelphi University, Garden City
    Field trip date(s): July 22-26, 2019
    Equipment/supplies to be provided: By participant: Notebooks and pen
    Immunization required: N/A
    Physical activities to be undertaken include: N/A
    Risks inherent in this field trip include bodily injury due to: Students engaging in traditional classroom activities
  • I acknowledge that there are certain risks inherent in field trips, including, but not limited to, those indicated in Section 1, and that all risks cannot be prevented. I acknowledge that my minor child is physically able, with or without accommodation, to participate in this field trip and to use the equipment and/or supplies described above.

    Should my minor child require emergency medical treatment as a result of accident or illness arising during the field trip, I consent to such treatment. I acknowledge that Adelphi University does not provide health and accident insurance for field trip participants and I agree to be financially responsible for any medical treatment. I will notify the trip leader if my minor child has medical conditions about which emergency medical personnel should be informed. In case of an emergency, please contact me at the number listed below.
  • (Include area code and extension, if applicable.)
  • Date Format: MM slash DD slash YYYY

For more information, please contact:

Robert Linné
p – 516.877.4411
e –

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