DC Trip
Dear Parent/Guardian,

Below are the permission forms for your child to attend the multitude of wonderful learning opportunities your child will be participating in during the period of April 26-April 28 in Washington D.C.!!

The objective of this program is to dedicate school days to immersion into their study and understanding of civics, government, and history. Your child will participate in many activities that will help them gain a better understanding of these topics, as well as hopefully inspire them to become an active United States citizen!

Please fill out and submit the below forms by Friday, April 7.
1. HPS Overnight Permission Form
2. HMS Info & Medical Form

We look forward to a unique and fun learning opportunity for all of these students during this "HMS Civics Week"!!!

Sincerely,
Derek Smith, HMS Principal
Alison Janulewicz, HMS Asst Principal
David Riordan HMS Asst Principal

Andy Hoey
Director of HPS Social Studies Department

Mr. Galvin, Mr. Huntington, Mr. McCulloch-Class Advisers

Sign in to Google to save your progress. Learn more
Email *
Hingham Public Schools Overnight/International Trip Consent Form, Release From Liability & Indemnity Agreement (Parent)
I/We, the undersigned parent(s) or guardian(s) of the above named student, a minor do hereby CONSENT to his/her participation in the Civics Week Program educational trip to Washington, D.C. (hereinafter referred to as the "Program") planned for April 26 through April 28, 2023, and sponsored by the Hingham Public Schools.

I/We forever RELEASE and discharge the Town of Hingham and its departments, officers, employees, and agents (hereinafter collectively referred to as Hingham), from any and all claims, damages, losses or expenses of whatever kind of nature which I/we may have or acquire as the parent(s) or guardian(s) of said minor out of or resulting, directly or indirectly, from said minor's participation in the Program. I/We also RELEASE and discharge Hingham from any and all claims, damages, losses or expenses of whatever kind of nature which said minor may have or acquire arising out of or resulting from, directly or indirectly, his/her participation in the Program.

I/We furthermore agree to defend and INDEMNIFY Hingham against all claims, damages, losses or expenses of whatever kind of nature which said minor may have or acquire arising out of or resulting from, directly or indirectly, his/her participation in the Program.

I/We furthermore agree to defend and INDEMNIFY Hingham against all claims, damages, losses or expenses of whatever kind or nature that Hingham may have to pay that arises from said minor's intentional, grossly negligent, or reckless acts or omissions while participating in the Program.

I/We hereby authorize Hingham's employee(s) or agent(s) who is supervising said minor, and/or the host family of said minor (if applicable) to act on our behalf in authorizing and consenting to emergency medical care including surgery, if necessary, dental care, and/or hospitalization for said minor if he/she becomes ill or is injured while participating in the Program. This Authorization and Consent may be presented to the appropriate medical/dental staff at such time as emergency medical care, dental care or hospitalization is required. I/We hereby RELEASE and discharge Hingham from any and all claims of any nature whatsoever, which may arise out of the decision to provide medical care, dental care or hospitalization during the Program.

I/We also hereby authorize Hingham, acting through the Superintendent of Public Schools or his/her designee, to cancel, reschedule or alter in any other manner the Program whenever he/she determines in his/her sole discretion that such cancellation, rescheduling or alteration is required in order to protect the safety and welfare of said minor. I/We agree to release Hingham from any claim for damages or loss that I/we may incur by reason of such cancellation, rescheduling or alteration.

I/We further authorize Hingham's employee(s) or agent(s) who is supervising said minor while participating in the Program to require said minor to comply with any rules, standards of behavior or instructions and shall have the further right to terminate said minor's participation in the Program at any time when such employee(s) or agent(s) considers the conduct of said minor incompatible with the interest, harmony, comfort or welfare of the other participants in the Program or with said minor's own safety or welfare. Possession, sale, distribution or use of illegal drugs, alcohol or a weapon(s) will constitute grounds for terminating said minor's participation. If said minor's participation is terminated, I/we consent to have said minor sent home in the most expeditious manner without refund at my/our expense. I/We accept in good faith the determination of such employee(s) or agent(s) in all matters relating to the supervision of said minor while in the Program.
Your Name *
Relationship *
Date *
MM
/
DD
/
YYYY
Student Last Name/Student First Name *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Hingham Public Schools. Report Abuse