Field Trip Registration

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Order #
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Current Date
MM slash DD slash YYYY
There are 5 spots remaining for the San Diego Zoo Safari Park Field Trip on February 9, 2024.
There are 0 spots remaining for the San Diego Zoo Safari Park Field Trip on February 20, 2024.
There are 14 spots remaining for the San Diego Zoo Field Trip on Wednesday, March 6, 2024.
There are 0 spots remaining for the Santee Lakes Recreation Park Field Trip on Thursday, March 7, 2024.
PERMISSION, RELEASE, WAIVER, AND ASSUMPTION OF RISK AGREEMENT
I, the undersigned parent/legal guardian (“Parent”) of the below named student (“Student”) of MATER DEI CATHOLIC HIGH SCHOOL (“MDCHS”), and the Student if the Student is 18 years of age or older, requests and grants permission for Student to participate in , located at on from approximately (“Activity”). In consideration for MDCHS permitting Student to participate in the Activity, I agree to the terms and conditions of this Permission, Release, Waiver, and Assumption of Risk Agreement (“Agreement”) as set forth herein (Parent and MDCHS are sometimes collectively referred to herein as “Parties”):
MDCHS Student Name*
Please enter the name of the student attending the event.
First Name Last Name
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Student ID#
Please enter the student's 4-Digit Student ID#
1. Informed & Voluntary Consent:I understand and acknowledge that my consent for Student to participate in the Activity is strictly voluntary and that I may decline to provide permission for Student to participate in the Activity. I understand that Student’s participation in the Activity is not required for graduation or part of any mandatory coursework. I have read and familiarized myself with the Information and Itinerary about the Activity attached hereto as Exhibit A and incorporated herein by reference.
2. Transportation:I understand and agree that MDCHS will be coordinating, organizing, overseeing, or supervising Student’s transportation to and from the Activity and MDCHS in a . I understand and agree that I am solely and fully responsible for arranging Students’ transportation to and from the Activity drop off and pick up location, and I accept full liability for such transportation.
3. Student Conduct:I agree that Student must adhere to all MDCHS rules and policies for student conduct, including those set forth in the Parent/Guardian and Student Handbook, while participating in the Activity. I further agree that MDCHS has the right, in its sole and absolute discretion, to terminate Student’s participation in the Activity at any time for conduct in violation of any MDCHS rule or policy or for any conduct MDCHS deems detrimental to MDCHS, Student, or any other party, as solely determined by MDCHS.
4. Consent to Medical & Dental Treatment:I understand and agree that in the event of an injury to Student or Student illness, MDCHS will make reasonable efforts under the circumstances to contact the Parent(s) and/or Student’s emergency contact. In case of injury to Student or Student illness, I authorize MDCHS and its employees, volunteers, agents, and representatives to administer first aid treatment to Student as deemed necessary, and to take Student to the hospital, urgent care center, or other health care provider, and I consent to any x-ray examination, anesthetic, surgical, or other medical treatment rendered by a physician, nurse, or other health care practitioner or emergency services provider. I consent to MDCHS using and disclosing Student’s protected health information as needed related to any x-ray examination, anesthetic, surgical, or other medical treatment. I understand and acknowledge that this authorization is given in advance of any specific injury or illness. I agree to pay all costs of medical care and services provided to Student while participating in the Activity.
5. Acknowledgement & Assumption of Risk:I acknowledge and agree that there are many inherent risks, known and unknown, involved with Student participating in the Activity, including, but not limited to: exposure to or infection of COVID-19 or other illness or infectious disease emotional distress; and damage to or loss of personal property, life, limb, or other injury. Nevertheless, I expressly assume responsibility for all risks associated with Student participating in the Activity whether or not described in this Agreement, known or unknown, or inherent or otherwise.
6. Voluntary Release of All Claims:I, on behalf of myself and Student, hereby voluntarily release, waive, discharge, covenant not to sue, and relinquish the Catholic Diocese of San Diego and MDCHS along with their officers, directors, board members, administrators, employees, clergy, agents, and representatives (collectively “the Released Parties”) from any and all claims, demands and liabilities, including for personal injuries, accidents or illness (including death), emotional distress, and property damage or loss (“Claims”) arising from Student participating in the Activity, except to the extent caused by the gross negligence or intentional misconduct of the Released Parties or each of them. I agree the intent of this Agreement to relieve the Released Parties from negligence to the greatest extent permitted by law.
7. Release of Third Party Liability:I acknowledge that MDCHS is not an agent of, and has no responsibility for, any third party, including without limitation any third party that may provide any goods or services related to the Activity. I, on behalf of myself and Student, hereby voluntarily release, waive, discharge, covenant not to sue, and relinquish the Released Parties from any and all Claims in any way related to or arising out of any acts, omissions, negligence, or intentional misconduct of any third party that may provide any goods or services related to the Activity.
8. Indemnification and Hold Harmless:To the fullest extent permitted by law, I agree to defend, indemnify, and hold the Released Parties, and each of them, harmless from and against any and all Claims related to or in any way caused by me or the Student related to the Student’s participation in the Activity.
9. Entire Agreement:This Agreement, the Parent/Guardian and Student Handbook, the enrollment agreement, and Exhibit A constitute a single, integrated agreement expressing the entire Agreement of the Parties with regard to the subject matter addressed in this Agreement. This Agreement may be modified or superseded only in a written instrument that specifically references the Agreement and is executed by all Parties. If any provision of this Agreement or the application thereof is held invalid, the invalidity shall not affect other provision(s) or applications of the Agreement that can be given effect without the invalid provisions or application and to this end, the provisions of this Agreement are severable. This Agreement is governed by the laws of the State of California.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS AND CONDITIONS, AND UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE. I UNDERSTAND THAT I HAVE RECEIVED THE OPPORTUNITY TO SEEK LEGAL COUNSEL AND ASK QUESTIONS BEFORE SIGNING THIS AGREEMENT. I ACKNOWLEDGE THAT I AM SIGNING THIS AGREEMENT FREELY AND VOLUNTARILY AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
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Off-Campus Activity*
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Date of Off-Campus Activity*
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Time of Off-Campus Activity*
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Location*
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Transportation*
Total
$0.00
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Total Checker

ELECTRONIC SIGNATURE CONSENT & DISCLOSURE

BY SIGNING MY NAME AND CLICKING THE “I AGREE” BUTTON, I AM CERTIFYING THAT I AGREE TO SUBMIT THIS AGREEMENT ELECTRONICALLY. I AM VERIFYING THAT I AM THE PERSON WHOSE NAME APPEARS ABOVE AND AGREE THAT TYPING MY NAME AND CLICKING “SUBMIT” IS THE LEGAL EQUIVALENT TO A MANUAL SIGNATURE ON A DOCUMENT.

Unless one parent/legal guardian has had his/her parental rights terminated by court order, both living parents/legal guardians must sign this Agreement.
Student
Name*
First Name Last Name
Date of Birth*
MM slash DD slash YYYY
PARENT/LEGAL GUARDIAN 1
Name*
First Name Last Name
Phone Number*
Date*
MM slash DD slash YYYY
Signature*
PARENT/LEGAL GUARDIAN 2
Name
First Name Last Name
Phone Number
Date
MM slash DD slash YYYY
Signature
EMERGENCY CONTACT
Name*
First Name Last Name
Phone Number*
HEALTH INSURANCE
Health Insurance Provider*
Policy Number*
Food Allergies/Special Dietary Needs*

Please list any special allergies or special dietary needs. To add additional food allergies or special dietary needs please click the + button to the right of the text box. (If none enter NA)
Medication Administration Disclosure*
All medications must be registered with the school nurse and turned over prior to the field trip. Over the counter and prescription medications can only be legally administered by field trip chaperones during field trips.
- I agree
Daily Medication*
Medication Dose Time

Please list any medications your child is taking above along with the dosage and timing. To add additional medications please click the + button to the right of the text box. (If none enter NA)
TOTAL
Total
$0.00

CART
San Diego Zoo Safari Park-0209*
Price:
San Diego Zoo Safari Park-0220*
Registration for the San Diego Zoo Safari Park Field Trip on February 20, 2024 is now full.
San Diego Zoo*
Price:
Santee Lakes Recreation Park*
Registration for the Santee Lakes Recreation Park Field Trip on Thursday, March 7, 2024 is now full.
Total
$0.00
Coupon
PAYMENT INFORMATION
Credit Card
Card Details
Cardholder Name
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Billing Email Address*
Enter Email Confirm Email
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Medication	Dose	Time

Field Trip Registration

Step 1 of 3

Student

PARENT/LEGAL GUARDIAN 1

PARENT/LEGAL GUARDIAN 2

EMERGENCY CONTACT

HEALTH INSURANCE

TOTAL

CART

PAYMENT INFORMATION