Charleston- Savannah Adventure



Georgia Trip Adventure

Application Form

To register for the trip, complete the following application and return it to your homeroom teacher along with your first payment of $125.00 or the full payment of $350.

(Payments made on is preferred)

Student Name: _____________________________________ Date of Birth: ___________________

Parent Name (s): ___________________________________ Phone: _________________________

Business/ Emergency Number(s): ______________________________________________________

Address: _____________________________________________________________________

_____________________________________________________________________

**** PLEASE READ AND SIGN IN THE TWO (2) APPROPRIATE PLACES ****

I give permission for my child to participate in the South Forsyth Middle School’s Georgia Trip Adventure on May 16-18, 2018. I understand that once I commit to this activity no refunds can be made until all trip expenses have been met; a minimum cancellation fee will be applied. I understand that my child may be denied participation at any time in this learning opportunity by a teacher, administrator, or by a Jim Mulvihill Tours associate if his/ her behavior detracts significantly from the learning environment of others. I understand that South Forsyth Middle School and Jim Mulvihill Tours act as agents in this activity and shall not be liable for any injury, damage, loss, delay, or any other irregularities that occur as the fault of service providers (Bus Company, museums, hotels, etc.) on this trip.

Signature of Parent/ Guardian ______________________________________

HEALTH INSURANCE AND MEDICAL INFORMATION-

Please provide all information and sign where required.

Health Insurance Co. ___________________ Policy Number ___________________

Group Number ________________________ Provider Phone # __________________

I agree to pay for any and all treatment not covered by my insurance program should the need arise.

In the event my child is injured or becomes ill while away from school on the Eighth Grade Georgia Adventure Trip,

May 16-18, 2018, I understand that the chaperones will immediately seek medical attention for my child and contact me as soon as possible at the number(s) listed above. I further agree to hold Forsyth County School District, its employees, and agents harmless of any injury or sickness directly caused by the negligence of persons other than the employees or agents of the Forsyth County School District when such injury or sickness occurs on this trip.

Signature of Parent/ Guardian ______________________________________

All students must be insured. An affordable health insurance policy is available if the child is uninsured.

Does your child have special medical needs or food allergies? (Medication, allergies, etc.)

Please use the space below and the back if necessary to explain in detail.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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