• Leon County School Board

  • This electronic form will add the information you enter along with your electronic signatures into the approvel Leon County School Board Application for Activity Participation. The original version of this form can be found at this link: https://www.leonschools.net/cms/lib/FL01903265/Centricity/Domain/1128/Application_for_Activity_Participation.pdf

  • APPLICATION FOR ACTIVITY PARTICIPATION

  • have read and understood all sections of this form that apply to my child. I certify that* who is a student and whose name is as it appears on his/her birth certificate, is my child or my legal ward, resides with me, and has been residing with me since (date) * at the following address:   *   *   (ZIP). I also state that we are now living within the attendance boundaries or have been reassigned by the district to   *   school.

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  • PERMISSION FOR SUPERVISED FIELD AND ACTIVITY TRIPS

  • During the school year, it sometimes becomes desirable to add to the educational experience of our students through planned visits to points outside of the school building. The visit might be a short field trip to a local point of educational interest, or on the middle and senior high school level, it might involve representing the school out of town in some group activity, such as band, chorus, athletic, academic, service club events, etc.

    We request that you grant permission for your child to participate in any such trip during the entire school year so that we may keep this form on file and avoid the necessity of asking for such permission on each occasion. The Leon County School Board has authorized the use of buses, private passenger cars and those approved vans that meet all of the Federal Safety Standards to transport students to any such trips. Notification will be provided to you concerning the type of transportation to be used. School officials will provide trip itinerary for all out of county trips.

  • Part 1: CONSENT

    You MUST fill out either the Part 1 CONSENT or Part II NON CONSENT to either give or deny permission for your child to travel with the band.

  • The undersigned as parent or guardian gives consent for the participant to use the Leon County School Board - approved means of transportation as a representative of School for the supervised field and/or activity trips.

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  • PART II: NON CONSENT

    ONLY FILL OUT THIS SECTION IF DO NOT GIVE PERMISSION FOR PARTICIPATION. You MUST fill out either the Part 1 CONSENT or Part II NON CONSENT to either give or deny permission for your child to travel with the band.

  • The undersigned as parent or guardian does not give consent for the participation to use the Leon County School Board - approved means of transportation as a representative of School for the supervised field and/or activity trips.

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  • MEDICAL RELEASE

  • PART I: CONSENT

    You MUST fill out either the Part 1 CONSENT or Part II NON CONSENT to either give or deny permission for the band to provide emergency medical care, if needed.

  • The undersigned as the parent(s) and/or legal guardian(s) of do hereby authorize the agent or officials of the Leon County School Board to obtain, through a physician of its choice, any emergency medical care that may become reasonably necessary for the student in the course of such athletic activities or such travel. No action shall be taken until an attempt is made to contact me at the phone number(s) listed below. Payment of all charges incurred for medical treatment is guaranteed by parent/guardian or the insurance company providing coverage for above named student.
    Home Phone Business Phone      

  • IN WITNESS of our consent and agreement to the matters stated above, we have subscribed our signature below.

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  • PART II: NON-CONSENT

    ONLY FILL OUT THIS SECTION IF DO NOT GIVE PERMISSION FOR MEDICAL RELEASE. You MUST fill out either the Part 1 CONSENT or Part II NON CONSENT to either give or deny permission for the band to provide emergency medical care, if needed.

  • As parent or guardian of , I do not desire to sign the medical and surgical release form above.

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  • INSURANCE

  • As parent or guardian of the student identified herein, I understand that the School Board of Leon County is not liable for injuries to participants in school activities. I further understand that all students shall be required to have proper medical insurance before they will be permitted to practice and participate in any co-curricular activity or field trip program.

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  • The following options shall be the only acceptable ones: (Please check your selected option.)

  • 1. = Personal Medical Insurance. The use of your personal medical or active/retired military insurance shall cover the activity(s) that your son or daughter will be participating in the current school year, and the insurance covers a minimum of $25,000.
    Company Policy Number

  • 2. = Student Activities Insurance Made Available through the School Board of Leon County. The cost of the insurance to be paid by the student participating (each year the county will publish the School Board of Leon County Insurance Plan for students). See school front office for details.

     

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