PERMISSION FORM

FOR PARTICIPATION IN FIELD TRIP

(Print out, complete, and bring to SAYSO)

Dear Parent/Guardian:

Your son/daughter is eligible to participate in a SAYSO-sponsored activity requiring transportation to a location away from your home. This activity will take place under the guidance and supervision of coaches, administrators, and other SAYSO representatives. A brief description of the activity is as follows:

Event: _______________________________________________________________

Destination: ______________________________________________________________

Designated Leader: ________________________________________________________

Date and Time of Departure: _________________________________________________

Date and Anticipated Time of Return: __________________________________________

Method of Transportation: __________________________________________________

Cost: __________________________________________________________________

If you would like your child to participate in this event, please complete, sign and return the following statement of consent and release of liability. As parent/guardian, you remain fully responsible for any legal liability that may result from any personal actions taken by your child. If you have any updated information relating to your child or his/her participation in this event, please advise SAYSO as soon as possible.

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I request that my child participate in this event. I understand that this event will take place away from home and that my child will be under supervision of the Leader named above. I consent to the conditions of the event stated above, including the method of transportation.

I understand and agree that, in the event that my child should suffer injury of any sort while participating in this event, I will not seek to pursue any claims against the Leader named above, SAYSO, and/or any of its agents, servants, employees or volunteers, unless such injury is caused solely by the intentional or grossly negligent conduct of the named Leader, in which case, I will pursue all of the CYSA/USYS administrative remedies available to me.

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(Signature of first Parent/Guardian)

______________________________________________

(Signature of second Parent/Guardian)

Please return this entire form to SAYSO by _________________