I give my consent for my child to participate in the field trips/other activities for the current school year.

I further give my legal consent and authorize any representative of U.S.D. 509 schools to authorize emergency medical treatment, including any necessary sugery or hospitalization, for my above named child, for any injury or illness of an emergency nature he/she incurred while participating in the field trip or other activity noted above by any physician or dentist licensed in accordance with the provisions of the Kansas Healing Arts Act, K.S.A. 65-2801 and any hospital.

I acknowledge and agree to pay and assume all responsibility for medical and hospital expenses and any other emergency services incurred on behalf of my child. If my child requires emergency medical treatment, I understand that school personnel will make a reasonable attempt to contact me to seek my permission to authorize treatment. To facilitate contacting me, I agree to provide current work and home phone numbers to the school. 
A photocopy of this document shall have the same force and effect as the original.