Enrichment Activity – Offsite Permission Form

Activity:  Field Trip to Rocky Creek Dairy Farm

Description:  Our K-5th Grades will be traveling to Rocky Creek Dairy to take a tour.  We will be leaving after lunch and returning around 2pm.

Location: 178 Holstein Lane Olin, NC 28660
Date:  May 12th, 2021
Time: 11:30am -2:00pm
Cost:  Free

Headwaters Permission Form

  • I give permission for my child to take part in this activity.
  • I am fully aware that my child will be transported to and from this activity and that there will be ample supervision. I have previously completed a Medical/Liability Release Form for my child. By signing this permission slip, I am confirming that the information on his/her Medical/Liability Release Form is current and up to date. I understand in the unlikely event of an accident or emergency that my child will receive adequate care based upon the information given. I assume all risks, hazards and incidentals involved in the conduct of the activity. I do hereby release, indemnify and hold harmless Headwaters Educational Enrichment and South River Baptist Church from any and all loss, injury or other damage arising out of this activity. I understand that the child will be transported to and from the offiste activity and I also understand the inherent risks in any travel, and agree to waive any and all liability on behalf of the referenced organizations for those risks.
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  • This field is for validation purposes and should be left unchanged.