Field Trip Authorization Form

CSUS-SSD YOUTH ACADEMY FIELD TRIP AUTHORIZATION FORM A completed (including parent/guardian signature) Field Trip Authorization form must be submitted prior to participation in the CSUS-SSD Youth Academy. Verbal Authorizations cannot be accepted.

As participants in the CSUS-SSD Youth Academy, participants will travel by bus or van to the locations listed below:

Monday July 18, 2016: SSD Training Facility 1000 Riverwalk Way Carmichael 95608 Tuesday July 19: SSD Air Operations Facility 3846 Bazley Mather 95655 STAR6 Memorial Lake Natoma Park Wednesday July 20: SSD Firearms Training Facility 12500 Bruceville Road Elk Grove 95757 Thursday July 21: Sacramento County Courthouse 720 9th Street Sacramento 95814 SSD Headquarters 711 G Street Sacramento 95814 Friday July 22: SSD Youth Services Bureau Croydon Way Rancho Cordova 95670

Student Name:

Parent/Guardian Name:

Home/Cell/Work Telephone: (Best way to reach you during trip)

By signing below, I acknowledge and agree as follows:

1. Participation in the CSUS-SSD Law Enforcement Youth Academy is voluntary and is a privilege. I request that my son/daughter be allowed to participate in the Field Trip, under the supervision of Sacramento County Sheriff’s Department (SSD) staff.

2. All persons participating on the field trip shall be deemed to have waived all claims against the Sacramento County Sheriff’s Department and participating agencies for injury, accident, illness or death occurring during or by reason of the field trip or excursion. I understand and agree that I cannot hold the Sacramento County Sheriff’s Department and participating agencies for any claim arising out of, or which is in some manner connected with participation in the Field Trips.

3. Sheriff’s Department staff will discuss Field Trip rules and safety requirements with the participants prior to the Field Trip, which may include dangerous or hazardous conditions or circumstances exposing the participant to potential harm, injury or death. Participants are required to obey all rules and safety requirements of the Field Trip, as well as general standards for respect of persons, property and courteous behavior. I understand and agree that failure of my son/daughter to follow Field Trip rules or safety requirements may result in them being sent home and may be barred from future Field Trips and/or remaining days of the CSUS-SSD Youth Academy.

4. If an injury or medical emergency occurs during the Field Trip, the Sacramento County Sheriff’s Department has my express permission to administrator or to authorize the administration of urgent or emergency care, including the transportation of my son/daughter to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. All costs and expenses associated with such care are solely my responsibility.

Parent/Guardian Printed Name ______

Signature______Date______