KAMEHAMEHA SCHOOLS. Permission to Participate In Field Trip/Activity and Release. Studentʻs Name: Activity Planned: Date of Activity:

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1 KAMEHAMEHA SCHOOLS Permission to Participate In Field Trip/Activity and Release Studentʻs Name: Class: Church- Corner of Lono & Kamehameha Ave. 10/4/18, 3:00-4:30 Activity Planned: Date of Activity: 1. Purpose of Trip/Activity: To provide students and parents the opportunity to meet with the admission counselors from a variety of Christian college in a relaxed setting. Event to be held at Kahului Union Church, 3:00-4:30pm 2. Supervision of Students: Rev. Kalani Wong None 3. Special Requirements: On own or via school mini-bus (first 14 to sign up) 4. Transportation: n/a 5. Air Travel: Provided by KSM? Yes No If no, provider: Date Flight # Christian College Reception at Kahului Union Depart / Arrival Location Time: am/pm Carrier 6. Ground Transportation Date: N/A Time: Carrier: N/A 7. Hotel: Phone: 8. Classes to be missed: Teacher signature indicates permission for class to be missed. Block Teacher Signature Bock Teacher Signature 1A 1B 2A 2B 3A 3B 4A 4B

2 KAMEHAMEHA SCHOOLS Permission to Participate in Field Trip/Activity and Release Studentʻs Name: Event/Activity: Christian College Reception PART TWO: To be completed by parents/guardians: 9. Expectations and Instructions: I/we understand that my/our child is expected to, and my/our child has been instructed by me/us to do exactly what he/she is instructed to do by the adult staff/volunteer, and to comply with all special requirements, including those listed in #3, on the informational cover letter. Notice of Acknowledgement of KSʻ Procedures Governing Student Behavior While traveling with KS Groups Students who participate in school-related field trips/activities are expected to observe the policies and procedures contained in the applicable campus Student and Parent Handbook or program guidelines. The rules of common courtesy must be followed in order to have harmonious relationships during the trip and students must exercise the highest standard of conduct in order to reflect favorably upon themselves, their fellow travelers and their school. When traveling, it is essential that students are familiar with and understand all travel guidelines and expectations. Disregard for the rules by a student may result in disciplinary action such as a call to the parents or guardian and an immediate return home at the studentʻs/parentsʻ expense. Serious infractions may result in further disciplinary action up to and including release from KS. 10. Insurance and Release: I /we represent that the student has insurance through my/our own insurance carrier and that any claims for accidental injuries must be filed by me/us with my own insurance carrier before presenting a claim to KS. I/we request that the above-named student be allowed to participate in the trip/activity planned, and I/we hereby specifically consent to his/her participation. If any emergency medical procedure or treatment is required during the trip/activity, I/we consent to the trip/activity supervisor(s) taking, arranging for or consenting to the procedure or treatment in his, her, or their discretion. In consideration for allowing my/our child to participate in the above-described field trip/activity and on behalf of myself/ourselves, my/our personal representatives,

3 my/our heirs, my/our assignees and my/our child, I/we hereby waive and release any and all claims against KS and its Trustees, officers, directors, agents, representatives and employees, in both their personal and professional capacities (collectively also KS ), for injuries, liabilities, losses, or damages connected with or arising out of my/our childʻs participation in the trip/activity, my/our childʻs transportation to or from the trip/activity, or the rendering of emergency medical procedures or treatment, if any. 11. Notice and Acknowledgement of KSʻ Policy Governing Withdrawal of Travel Endorsement: This Notice must be provided to every parent/legal guardian, and the acknowledgement signed and returned, in order for students to participate in offisland travel/field trips/activities. This requirement extends to all KS Clubs and Organizations as part of the permission process. KS reserves the right to withdraw its endorsement at any time when the applicable KS school administrator, deems such action advisable in the best interests of KS. Along with the right to withdraw its endorsement, KS reserves the right to withdraw all grants or financial aid, (if applicable), for the planned trip/activity. Withdrawal of KS endorsement means that the trip/activity shall no longer be authorized as a school sponsored trip/activity (e.g., the trip/activity will no longer be designated as the "Kamehameha Schools Warrior Band Tour" or "Kamehameha Schools Hawaiian Ensemble Tour," etc.). If the trip proceeds, it will not be a performance tour, but merely a vacation tour. Accordingly, all performances, games, etc., where the group is scheduled to appear and perform as a school organization shall be canceled. No KS equipment (e.g., band instruments, uniforms, sports equipment, etc.) will be provided to the organization for the trip. Any KS staff member who desires to proceed with the trip after KS has withdrawn its endorsement shall do so in an individual capacity, and shall not be deemed an authorized representative of KS. Note: Money raised through fundraising efforts are considered the property of Kamehameha Schools and the school determines how the funds are to be spent. In the event of a cancellation of an activity and/or travel, any fundraised monies are non-refundable. Only parent contributions, not fundraised monies, may be returned to families. 12. Cancelation Policy: I/we understand that all trips/activities are subject to the terms described in the Notice regarding KSʻ Policy on Withdrawal of Travel Endorsement and Acknowledgement. I/we am returning a signed acknowledgement of this policy if this trip involves off-island travel. 13. Permission for Alternate Transportation I/We understand that the standard transportation method for students at

4 Kamehameha Schools is via a KS approved school vehicles(s) form KS premises to the field trip/activity site(s) and back to KS premises. In the event that my/our child is to be transported in a vehicle other than a Type I or II school bus to and from a school function or school-related activity, I/We agree to waive, release and hold harmless the State of Hawaii, HAIS and Kamehameha Schools from any responsibility for injuries, liabilities, losses or damages connected with or arising out of the transportation of my/our child in a vehicle other than a Type I or II school bus. I/We request permission to make a change from the is standard transportation method by the following methods(s) [please check all that apply]: I/We will transport my/our child and sign him/her in/out at the field trip/activity site. I/We authorize my/our child who has a valid State of Hawaii motor vehicle driverʻs license to transport himself/herself and sign in/out at the field trip/activity site. I/We have designated another adult to transport my/our child and sign him/her in/out from the field trip/activity site. Name of Responsible Adult: In consideration for allowing me to deviate from KSʻ scheduled method of transportation, and on behalf of myself/ourselves, my/our personal representatives, my/our heirs, my/our assignees and my/our child, I/We (a) waive and release any and all claims against KS, and its Trustees, officers, directors, agents, representatives and employees, in both their personal and professional capacities. (collectively also KS ), for injuries, liabilities, losses or damages connected with or arising out of my deviation from KSʻ scheduled method of transportation for my/our child; and (b) we agree to indemnify, defend and forever hold harmless, KS from and against any and all claims, proceedings, injuries, liabilities, losses damages, and expenses including reasonable attorney fees and costs, relating to the alternative transportation arrangements for my/our child 14. Leptospirosis Acknowledgement (applicable for all water activities): I/we have reviewed the KS Program Services Fact Sheet on Leptospirosis. Check the appropriate box. My child does NOT have permission to participate in the activity. I understand that my child must participate in alternate activities at the field trip site to fulfill the curricular requirements of the excursion. My child may participate in the planned activity. My child may participate in the planned activity with the following restrictions please list.

5 15. Indemnification Statement: In consideration for allowing my/our child to participate in the above-described trip/activity, I/we agree to indemnify, defend, and forever hold harmless KS from and against any and all claims, proceedings, injuries, liabilities, losses, damages and expenses including reasonable attorney fees and costs, relating to or arising out of the trip/activity, my/our childʻs transportation to or from the activity, or the rendering of required medical procedures or treatment, if any, to my/our child. 16. Parental Consent All Legal Parent/Guardian Must Sign I/we have read the information about the Kamehameha Schoolsʻ Teen's Under Construction- Christian College Reception Name of class, team or club plans for a field trip/activity as described in detail in this form. I/we have signed this permission form only after understanding and considering the information contained in this form. Fatherʻs/Guardianʻs Printed Name Fatherʻs/Guardianʻs Signature Date Motherʻs/Guardianʻs Printed Name Motherʻs/Guardianʻs Signature Date Address: Phone: Home: Cell: Work: (REV.1/2018 KSM)