Band Trip Registration Forms

Trip Destination: Chicago, IL
Dates: March 4-7, 2016
Band Directors: Donna M. Novey, Scott J. Fairweather
Parent Chaperones: Beth Dietz, Kari Jaksha, David Musielewicz, and Randall Anderson


MEDICAL INFORMATION
It is recommended that students bring a copy of their insurance card.

MEDICAL DATA
(please explain where you answer "Yes")
Does the student have any dietary restrictions? *
Does the student take any prescription or non-prescription medications? *
Does the student have any other medical conditions which we should know about, i.e. allergies, asthma or seizures? *
If your child needs medical treatment, we will seek care immediately. Treatment is at family expense.

OUR AGREEMENT WITH PARENT/GUARDIAN
The undersigned agree that our daughter/son has permission to participate in the CDH Band Trip to Chicago, IL. The permission includes travel from St. Paul to Chicago, IL and related travel destinations.The teachers and chaperones or staff at any of the attended sites will supervise all activities. Individual excursions are strictly forbidden, and curfew is imposed nightly. I (We) agree that my (our) son/daughter will abide by the rules of behavior and decorum outlined in the CDH handbook. Participants will recognize their responsibility to other members of the travel group and coordinators. One point of emphasis is that there will be absolutely no use of cigarettes, drugs or alcohol. Students who break school rules may be sent home at the expense of their parent/guardian. We also agree to pay any and all extra expenses incurred should our daughter or son be sent home early for breaking school or trip rules.

If any emergency medical procedures or treatment are required during the trip, we authorize and give our consent to the trip supervisor taking, arranging for, or consenting to procedures or treatment. In the event of an emergency, we can be reached at the telephone numbers listed earlier. The trip supervisor will make a reasonable attempt to reach the parent/guardian or the emergency contact when parents are unavailable.

I hereby give permission for my daughter/son to receive medical care as needed in an emergency, and I release, waive and agree to indemnify and hold harmless Cretin-Derham Hall High School, its employees, agents and representatives from and against all claims for losses, damages or injuries arising out of, during or in connection with the student's participation in the trip or the rendering of medical procedures or treatment, if any.

I (We) certify that all the above information is correct to the best of our knowledge. I (We) have signed this form only after understanding and fully considering the above. We will notify the band director in writing of any changes.

TYPING YOUR NAME AND THE DATE IN THE APPROPRIATE SPACE BELOW WILL SERVE AS YOUR ELECTRONIC SIGNATURE AND AGREEMENT WITH THE ABOVE.