DHS After School Liability Waivers 2021-2022

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form in the presence of your parent/guardian if you intend to stay after school for any service/club event at Discovery High School for school year 2021-2022.

This form only has to be completed ONE time per year.

Email *

Student Last Name *

Student First Name *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Phone Number *

Student Date of Birth (For emergency purposes) *

YYYY

Any known allergies? *

Any medical conditions? *

Current medications? *

Grade *

Freshman

Sophomore

Junior

Senior

1st Period Teacher *

Which group are you trying to earn service hours for? Select all that apply. If other, please specify. *

Environmental Club

StuCo

Beta

Titan Community Service Medal (100 Hours over 4 HS years)

National Honor Society

Other:

Required

Alternative Transportation Waiver: By typing your parent's name below, you are affirming your parents' knowledge of the transportation waiver for any event hosted by a DHS club this year. *

Photo/Name Release: By typing your parent's name below, you are affirming your parents' knowledge of the photo/name release for any event hosted by a DHS club this year. *

Liability Waiver: By typing your parent's name below, you are affirming your parents' knowledge of the liability waiver for any event hosted by a DHS club this year. *

MEDICAL TREATMENT CONSENT: By typing the parent's name below, you give consent to the Activity Organizer or their representative to obtain medical care from any licensed physician, hospital or clinic for the above named student for any injury or illness that may arise during this activity. In the event of sickness or accidents, I will not hold the activity organizer, facility administration or group sponsor responsible. In case of sickness or accident, I authorize the calling of a medical doctor and/or providing of other necessary medical services. I agree to pay for those medical services that are deemed necessary by medical authorities. *

Emergency Contact other than Parent/Guardian (Name and phone number) *

I understand that my student MUST be picked up upon activity completion. If he/she doesn't have a ride, he/she will not stay after. *

Yes, my student will be picked up on time.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Gwinnett County Public Schools. Report Abuse

Forms