Student Events Checklist and Permission Slip Request

Event/Trip Name*

Event/Trip Date*

Please specify what date you need this permission slip by. We need at least 48 hours notice before you'd like to send it out to participants.

Event/Trip Time

:

Event/Trip Location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is the purpose of your event/trip?*

If you answered "Other" above, please specify here.

On-Campus Events

For on-campus events, please confirm that you have reserved a space and approved an event for the academic calendar with Elisha Meyer.

Your Name*

First Last

Your Email*

Chaperone #1 Name*

First Last

Chaperone #1 Email*

Chaperone #2 Name*

First Last

Chaperone #2 Email*

Event Description*

You should include the exact information (word for word) you would like at the top of the form including where and when the event takes place, how students should get there, if there is a cost to students (and if financial aid is available), if they need to bring food or if it is provided, and when the permission slip is due. Also indicate if the destination has any requirements like vaccination or particular clothing/materials.

Please check the fields you would like included in your form.*

Please include any other fields you would like in your form that were not on the above list or that require further specification.

Will your trip/event involve any non-BUA students? If so, please explain in what capacity non-BUA students are involved and be prepared to follow up with Lizzy Karnaukh.

All forms will include the a check box for students to acknowledge what is written below this text box. If you would like to add anything else, please indicate that here.

- I understand that my parent must reply to the email confirming 1. my permission to attend this event and 2. their consent and release from liability. - I will follow the school rules as outlined in the Student Handbook.

All forms will also include the a check box for parents/guardians to acknowledge what is written below this text box. If you would like to add anything else, please indicate that here.

For Participation in Boston University Academy's (Event). 1. I hereby consent to the participation of the child named above in all activities at this Event as specified above. 2. I understand, recognize and acknowledge that this Event involves activities including, but not limited to academic and cultural experiences that may involve the risk of accident, death, illness, physical or mental injuries, and property damage. It is my responsibility to ask questions about any aspect of the Event activities that has not been explained to my satisfaction. I hereby voluntarily assume any and all risks, including injury to person and property, related to my child’s participation in the Event. 3. In consideration of Boston University allowing my child to participate in the Event, I, on behalf of myself, my child, and anyone claiming on behalf of me or my child hereby FOREVER RELEASE Trustees of Boston University (the “University”) and its departments, officers, directors, board members, representatives, agents, and employees from any and all claims, demands, causes of action, judgment, damages, expenses and costs (including attorneys’ fees), including but not limited to claims of negligence, on account of personal injury, bodily injury, property damage, death or accident of any kind sustained by my child that arises out of or is related in any way to his/her participation in the Program which I may now or hereafter have and which the above-named minor has or hereafter may acquire, either before or after reaching majority. 4. In signing this Parental Consent and Release from Liability, I hereby acknowledge that I have read this information, that I understand its terms, that I have signed it knowingly and voluntarily, and that I intend it to bind me, my minor child, and anyone claiming on behalf of me or my child. 5. I further acknowledge that I am the parent or legal guardian of the minor identified above, with legal authority to sign this document.

Is there anything else we should know about for this trip/event?

Student Events Checklist and Permission Slip Request

Event/Trip/Outing Permission Slip Request