SCHOOL, SPORTS & EXCURSION CHAPERONE CONSENT
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Effective Date: ________________________________________________________
Place: _________________________________________________________________

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1. Parties
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This document is made on ____________________ (____________________) by:

Parent / Legal Guardian
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

Addressed to:

Organizer
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

2. SUBJECT-MATTER SCHEDULE & SPECIFICATIONS
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Participant's Full Name: _______________________________________________
Activity / Excursion: __________________________________________________
Dates & Location: ______________________________________________________
Chaperone / Supervisor: ________________________________________________
Medical Notes & Allergies: _____________________________________________
Emergency Contact: _____________________________________________________

3. EXECUTION & SIGNATURES
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Parent / Legal Guardian

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________