School Field Trip Insurance Waiver Form
Student Information
Student Name
Grade
Date of Birth
Parent/Guardian Information
Parent/Guardian Name
Email
Phone Number
Trip Details
Trip Name
Trip Date
Destination
Insurance Information
Insurance Provider
Policy Number
Medical Information
Medical Conditions / Allergies
Emergency Contact Name
Emergency Contact Phone
Waiver and Acknowledgement
I hereby acknowledge and accept the risks involved in this field trip and waive the school of liability.
Parent/Guardian Signature
Date