Permission to Ride with District Approved Driver
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I understand that by completing this form I give permission for my student to ride with any Philomath School District approved volunteer/driver to and/or from school events scheduled through Philomath High School. *
Date *
MM
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Student Name *
Parent Name *
Only in court proven cases of school staff negligence does school insurance provide coverage for injuries to students occurring while they are under school supervision.  Medical expenses for other injuries or illness must be assumed by parents or by the parents' insurance.
Medical Insurance Information
If the school is unable to contact me, and it is deemed necessary, I give my permission for school personnel to secure emergency medical treatment for my son/daughter while on this trip.  I understand that I must assume the medical expenses that this might cause.

Insurance Company *
Policy Number *
Contact Information
Please provide a phone number where you can be reached in the event of an emergency.
Primary Phone Number *
Work Phone Number *
Emergency Contact Information
In the event that you can not be reached, please contact the following people.
Contact Name *
Contact Phone Number *
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