Iroquois-Kankakee ROE
Parental Consent for Participation
Field Trip /Activities
Event [Line for Event Name]
Date [Line for Date of Activity]
Location [Line for Location]
To whom it may concern:
I hereby give permission for my child, to participate in the [Line for Activity]. I also give permission to provide transportation and for any emergency medical care that will be performed by a licensed physician if necessary. I agree to be liable and to pay for all costs and expenses that might incur in connection with such medical or dental services that were rendered.
Upon returning to town, my child should be brought to [Line for location].
Please check one - This is [ ] / is not [ ] our home.
Parent / Guardian Signature: [Line for Signature]
Date: [Line for Date]
