NORTH COTTONWOOD ELEMENTARY SCHOOL 19920 Gas Point Road (physical) 20512 W. First St (naling) ‘Cottonwood, CA. 96022 'SB0387.108 PARENT/GUARDIAN CONSENT FORM. 1 (parent/guardian): So Give permission for my child: - oo To go to: Shasta Lanes Donation: $9.00 Tunderstand that my child will travel by: School Bus Day/date: Friday, April 27, 2018 Time leaving: 8:15am Time Returning: 10:45am. Tn granting this permission, I hereby expressly waive any claim for liability against the Board of Trustees or the Cottonwood Union School District, including, but not limited to, its employees, officers, administrators or representatives and release same from any and all liability in connection with the above travel and/or activity unless the sole and only proximate cause of said liabilities is theirs, | further do hereby authorize the employees of the Cottonwood Union School District, supervising the above activity and travel, as my agent {0 consent to any x-ray examination, anesthetic, medical or surpical diagnosis, treatment and hospital care upon the Medical Practice Act, no matter where such examination, anesthetic, diagnosis, treatment or care is performed or rendered. It is understood that this authorization is given in advance of any specific examination, anesthetic, diagnosis, treatment or care being required or recommended. This authorization is given to provide authority and power on the part of any employee of the District to give specific consent to any and all such examinations, anesthetic, diagnosis, treatment or care by the aforedescribed physicians or surgeons which they, in their individual or collective judgment, may deem advisable or recommended. ‘This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. Parent (s) /Guardian(s): _ Date: _ Policy Approved Cottonwood Union School District: October 12, 1987 By: DOUG GEREN, SUPERINTENDENT COTTONWOOD UNION SCHOOL DISTRICT irst Grade STAR students Classes going on field triNORTH COTTONWOOD ELEMENTARY SCHOOL 19920 Gas Point Road (physical) 20812 W. Fest St (mailing) Cottonwood, Ca 96022 'S30-347-1698 I (parent/guardian): Give permission for my child: - To go to: Shasta Lanes Donation: $9.00 [understand that my child will travel by: School Bus Day/date: Friday, April 27, 2018 Time leaving: 9:15am Time Returning: 11:45am In granting this permission, I hereby expressly waive any claim for liability against the Board of Trustees or the Cottonwood Union School District, including, but not limited to, its employees, officers, administrators or representatives and release same from any and all liability in connect with the above travel and/or activity unless the sole and only proximate cause of said liabilities theirs. 1 further do hereby authorize the employees of the Cottonwood Union School District, supervising the above activity and travel, as my agent to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment and hospital care upon the Medical Practice Act, no matter where such ‘examination, anesthetic, diagnosis, treatment or care is performed or rendered. Itis understood that this authorization is given in advance of any specific examination, anesthetic, diagnosis, treatment or care being required or recommended. ‘This authorization is given to provide authority and power on the part of any employee of the Distriet to give specific consent to any and all such examinations, anesthetic, diagnosis, treatment or care by the aforedescribed physicians or surgeons which they, in their individual or collective judgment, may deem advisable or recommended. il Code of California. This authorization is given pursuant to the provisions of Section 25.8 of the Ci Parent (s) /Guardian(s): Date: 1987 Policy Approved Cottonwood Union School District: October By: DOUG GEREN, SUPERINTENDENT COTTONWOOD UNION SCHOOL DISTRICT Second Grade STAR students Classes going on field trip:NORTH COTTONWOOD ELEMENTARY SCHOOL 19920 Gas Point Road (physical) 20512 W, First St (nil) ‘Cottonwoad, CA 96022 530-347-1698, 1 (parent/guardian): ee Give permission for my child: - To go to: Shasta Lanes Donation: $9.00 Tundersiand that my child will travel by: School Bus Day/date: Thursday, April 26, 2018 Time leaving: 8:15am. Time Returning: 10:45am In granting this permission, I hereby expressly waive any claim for liability against the Board of Trustees or the Cottonwood Union School District, including, but not limited to, its employees, officers, administrators or representatives and release same from any and all liability in connection with the above travel and/or activity unless the sole and only proximate cause of said liabilities is theirs. I further do hereby authorize the employees of the Cottonwood Union School District, supervising the above activity and travel, as my agent to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment and hospital care upon the Medical Practice Act, no matter where such examination, anesthetic, diagnosis, treatment or care is performed or rendered. Itis understood that this authorization is given in advance of any specific examination, anesthetic, diagnosis, treatment or care being required or recommended. This authorization is given to provide authority and power on the part of any employee of the District to give specific consent to any and all such examinations, anesthetic, diagnosis, treatment or care by the aforedescribed physicians or surgeons which they, in their individual or collective judgment, may deem advisable or recommended sions of Section 25.8 of the Civil Code of California ‘This authorization is given pursuant to the pro Parent (s) /Guardian(s): Date: Policy Approved Cottonwood Union School District: October 12, 1987 By; DOUG GEREN, SUPERINTENDENT COTTONWOOD UNION SCHOOL DISTRICT Classes going on field trip: Third Grade STAR studentsNORTH COTTONWOOD ELEMENTARY SCHOOL 19920 Gas Point Road (physeal) 20812 W. First St (niling) Cottonwood, CA 96022 ‘33057-1698 PARENT/GUARDIAN CO? 1 (parent/guardian): —_ a Give permission for my child: oe To go to: Shasta Lanes Donation: $9.00 T understand that my child will travel by: School Bus Day/date: Thursday, April 26, 2018 15am ‘Time Returning: 11:45am Time leaving: In granting this permission, I hereby expressly waive any claim for liability against the Board of Trustees o the Cottonwood Union School District, including, but not limited to, its employees, officers, administrators or representatives and release same from any and all liability in connection with the above travel and/or activity unless the sole and only proximate cause of said liabilities is, theirs. | further do hereby authorize the employees of the Cottonwood Union School District, supervising the above activity and travel, as my agent to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment and hospital care upon the Medical Practice Act, no matter where such examination, anesthetic, diagnosis, treatment or care is performed or rendered. It is understood that this authorization is given in advance of any specific examination, anesthetic, diagnosis, treatment or care being required or recommended. This authorization is given to provide authority and power on the part of any employee of the District to give specific consent to any and all such examinations, anesthetic, diagnosis, treatment or care by the aforedescribed physicians or surgeons which they, in their individual or collective judgment, may deem advisable or recommended, ‘This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. Parent (s) /Guardian(s): - - Date: _ _ Policy Approved Cottonwood Union School District: October 12, 1987 By: DOUG GEREN, SUPERINTENDENT COTTONWOOD UNION SCHOOL DISTRICT Classes going on field trip: Fourth Grade STAR studentsNORTH COTTONWOOD ELEMENTARY SCHOOL 19920 Gas Point Road (physical) 230812 W. Fest St. mlig) Cottonvoad, CA 96022 ‘530-347-1098 PARENT/GUARDIAN CONSENT FORM 1 (parent/guardian): _ a Give permission for my child: So To go to: Camden House Donation: $4.00 J understand that my child will travel by: School bus Day/date: Tuesday, April 24, 2018 Time leaving: 8:10 A.M. Time returning: 1:30 P.M. In granting this permission, I hereby expressly waive any claim for liability against the Board of Trustees or the Cottonwood Union School District, including, but not Ii ited to, its employees, officers, administrators or representatives and release same from any and all liability in connection with the above travel and/or activity unless the sole and only proximate cause of said liabilities is theirs. | further do hereby authorize the employees of the Cottonwood Union Schoo! District, supervising the above activity and travel, as my agent to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment and hospital care upon the Medical Practice Act, no matter where such examination, anesthetic, diagnosis, treatment or care is performed or rendered. tis understood that this authorization is given in advance of any specific examination, anesthetic, diagnosis, treatment or care being required or recommended. This authorization is given to provide authority and power on the patt of any employce of the District to give specific consent to any and all such examinations, anesthetic, diagnosis, treatment or care by the aforedescribed physicians or surgeons which they, in their individual or collective judgment, may deem advisable or recommended. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. Parent (s) /Guardian(s): _ _ Dat Policy Approved Cottonwood Union School District: October 12, 1987 By: DOUG GEREN, SUPERINTENDENT COTTONWOOD UNION SCHOOL DISTRICT Classes going on field trip: 4-Doty, 4-MeNeely, 4-LivingstonNORTH COTTONWOOD ELEMENTARY SCHOOL 19920 Gas Point Road (physical) 20812 W. First St (oling) Cottonood, CA 96022 530-347-1098, PARENT/GUARDIAN CONSENT FORM, 1 (parent/guardian): Give permission for my child: - — To go to: West Cottonwood School- 4" Grade Invasion Day T understand that my child will travel by: School Bus Day/date: Friday, May 25, 2018 ‘Time leaving: 8:15am Time Returning: 12:00pm In granting this permission, I hereby expressly waive any claim for liability against the Board of Trustees or the Cottonwood Union School District, including, but not limited to, its employees, officers, administrators or representatives and release same from any and all liability in connection with the above travel and/or activity unless the sole and only proximate cause of said liabilities is theirs. | further do hereby authorize the employees of the Cottonwood Union School District, supervising the above activity and travel, as my agent to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment and hospital care upon the Medical Practice Act, no matter where such examination, anesthetic, diagnosis, treatment or care is performed or rendered. It is understood that this authorization is given in advance of any specific examination, anesthetic, diagnosis, treatment or care being required or recommended. This authorization is given to provide authority and power on the part of any employee of the District to give specific consent to any and all such examinations, anesthetic, diagnosis, treatment or care by the aforedescribed physicians or surgeons which they, in their individual or collective judgment, may deem advisable or recommended, ions of Section 25.8 of the Civil Code of California. This authorization is given pursuant to the pro} Dat Parent (s) /Guardian(s) Policy Approved Cottonwood Union School District: October 12, 1987 By: DOUG GEREN, SUPERINTENDENT COTTONWOOD UNION SCHOOL DISTRICT **Students will be swimming, please send your student in their swimsuit under their clothing. Please send towel, sunscreen, and a bag for wet items. Students will have lunch at West Cottonwood Classes going on field trip: Fourth Grade StudentsTARY SCHOOL NORTH COTTONWOOD ELEM! 19920 Gas Point Road (physeal) 1 (parent/guardian): — Give permission for my child ‘To go to: REU-Turtle Bay T understand that my child will travel by: School Bus Day/date: Friday, April 27, 2018 Time leaving: 8:15am Time Returning: 1:15pm In granting this permission, I hereby expressly waive any claim for liability against the Board of Trustees or the Cottonwood Union School District, including, but not limited to, its employee: officers, administrators or representatives and release same from any and all liability in connection with the above travel and/or activity unless the sole and only proximate cause of said liabilities is theirs. | further do hereby authorize the employees of the Cottonwood Union Schoo! District, supervising the above activity and travel, as my agent to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment and hospital care upon the Medical Practice Act, no matter where such examination, anesthetic, diagnosis, treatment or care is performed or rendered. It is understood that this authorization is given in advance of any specific examination, anesthe diagnosis, treatment or care being required or recommended. This authorization is given to provide authority and power on the part of any employee of the District to give specific consent to any and all such examinations, anesthetic, diagnosis, treatment or care by the aforedeseribed physicians or surgeons which they, in their individual or collective judgment, may deem advisable or recommended, ion 25.8 of the Ci This authorization is given pursuant to the provisions of Se Parent (s) /Guardian(s): Date: - Policy Approved Cottonwood Union School District: October 12, 1987 By: DOUG GEREN, SUPERINTENDENT COTTONWOOD UNION SCHOOL DISTRICT My Student will need a school sack lunch YES or NO Classes going on field trip: 4-Doty, 4-Livingston, 4-MeNeely, 4-Spoto