superintendent, employees, and servants from any and all liability, damages, or claims
resulting from such student being allowed to travel and/or participate in school-approved
field trips, and I agree to hold them harmless from any damages or claims which might
arise from injuries out of any act or omission on the part of the District, other than
negligence in the operation of a motor vehicle, or the use of excessive force in the
administration of discipline, pursuant to Article 6252-19 of Texas Tort Claims Act, and
Section 22.051 of the Texas Education Code, as a result of such trip or activity.
In the event that the above-named student should, for any reason, require any minor
medical or surgical treatment and/or medication while participating in approved field trip
activities, I authorize the staff to take my child to an emergency room of the nearest
hospital, and I further authorize the hospital and its medical staff to administer treatment
as deemed necessary by them for the well-being of said student. It is understood,
however, that if hospitalization or treatment of a more serious nature is required I will be
contacted, if at all possible, for permission.
I have read and understand the above and I freely give my consent and permission of
all things contained herein.

______________________________________________________________________
Parent/Guardian
Signature
Date
NOTE: This form is to be completed by the parent/guardian, returned to the
classroom teacher, and remain a part of the student's permanent record folder for
the current year .
Form #4107900 Rev. 2002
Administration Building P.O. Box 152637 2621 W. Airport Freeway Irving, TX 75015-2637 Tel.972/215-5000