ACTIVITY PARTICIPATION FORM

Ski Trip at Mountain Creek Ski Resort!

If you are interested in having your child participate in this event, please complete all sections of
this form, sign and return to Morgan. Please contact Morgan with any questions.
__________________________________________(Name of student) is interested in participating
in the activity.
Please return this Activity Participation Form, as well as the Transportation Form ,
Medical Information and Authorization to Treat a Minor and General Release of
Liability Form with payment (cash or check made out to Fusion Academy) by

WEDNESDAY, FEBRUARY 17.

NATURE OF ACTIVITY:
DATE:
TIME OF DEPARTURE:
ANTICIPATED TIME
OF RETURN:
ACTIVITY SPONSOR:

ACTIVITY
INFORMATION:

COST:
METHOD OF
TRANSPORTATION:

Ski Trip for all Fusion Students

Friday, February 26, 2016
9:00am at Fusions Park Ave location at 450 Park Avenue South
Please arrive promptly so we can leave the city on time.
8:00 PM
*Please be at the campus at this time to pick up your child. The
chaperones will be in touch with the parents to relay any
changes in times if we are running ahead or behind schedule.
Morgan Geisert
All of the New York Fusions are joining together for a super exciting day
of skiing and snow tubing at Mountain Creek Ski Resort in Vernon
Township, NJ! The day will be spent skiing, snow tubing, and hanging out
with other Fusion folk in the Ski Lodge! The cost of the trip includes round
trip transportation, a meal voucher, ski lift tickets, rentals, a lesson, and
helmet. Please send your child with extra pocket money for snacks and
drinks.
For skiing only: $130
For snow tubing only: $80
Coach bus

Please place your initials after each statement below:

I understand the nature of the school activity in which my son/daughter will be
participating and that he/she is expected to abide by all school regulations during
the course of the activity.
_____
I acknowledge that I have signed the attached General Release of Liability Form.
_____
I acknowledge that I have signed the attached Medical Information and
Authorization to Treat a Minor Form.
_____
I acknowledge that I have signed the attached Transportation Release Form.
_____
Fusion Academy Morristown

182 South St. Suite 4 Morristown, NJ 07960

973.267.0474

I hereby give my permission for him/her to participate in the above-described

activity.
_____

__________________________________________________________________________________________
Signature of Parent/Guardian
Date

Parent Permission to Release Students to Authorized Person for Transportation

I, as parent or guardian, give permission for (print name of student) ______________________________ to be
transported to and/or from Fusion Academy located at 450 Park Ave South, New York, NY, during the period from
________________ to _________________. I release Fusion Academy, its officers, employees, agents, and affiliated
companies from any liability arising out of personal injuries and/or property damage resulting from or in any way
connected to my childs transport to and from school.
(All parents/guardians must sign)
_______________________________________
Signature of Parent/Guardian

_________________________
Home Telephone Number

_______________________________________
Address
_______________________________________

_________________________
Work Telephone Number

_______________________________________
Date ___________________________________

_______________________________________
Signature of Parent/Guardian

_________________________
Home Telephone Number

_______________________________________
Address
_______________________________________

_________________________
Work Telephone Number

_______________________________________
Date __________________________________

Fusion Academy Morristown

182 South St. Suite 4 Morristown, NJ 07960

973.267.0474

Medical Information and Authorization to Treat a Minor

Student Name:

Parent Name/Ph #:

Student Cell Phone Number:

Date:

*** THIS FORM WILL BE KEPT BY THE CHAPERONE DURING THE ACTIVITY***
List pertinent medication information (include severe allergies):
____________________________________________________________________________________
____________________________________________________________________________________
Emergency Contact Information:
Contact Name:

Relationship to Student:

Primary Contact:

Alternate Contact:

Authorization to Treat a Minor:

I (We), the undersigned parent, parents or legal guardian of
________________________________________, a minor, do hereby authorize and consent to
any x-ray examination, anesthetic, medical or surgical diagnosis and treatment and
emergency hospital care which is deemed advisable by an is to be rendered under the
general or special supervision of any member of the medical staff and emergency room
staff licensed under the provisions of the Medicine Practice Act and on the staff of any
acute general hospital holding a current license to operate a hospital from the state
department of public health. It is understood that effort shall be made to contact the
undersigned prior to rending treatment to the patient but that any of the above
treatment will not be withheld if the undersigned cannot be reached.
________________________________________
Fusion Academy Morristown

182 South St. Suite 4 Morristown, NJ 07960

973.267.0474

Parent/Guardian Signature

_____________________
Date

WAIVER AND GENERAL RELEASE OF LIABILITY

Required for all Sports, PE, and Extracurricular Participation

1. Permission and Voluntary Assumption of Risk: My child/ward has permission to participate in the Fusion Academy
and Learning Center sports and/or extracurricular program. Participation may include attendance at off-site activities
and sporting events. I understand and agree that my child/ward may be transported to activities in a school-owned
vehicle, or contracted/designated vehicle. I recognize that participation in (including trying-out, practicing, traveling
to, and playing) intramural, interscholastic, and recreational sport activities is a potentially hazardous activity posing
various safety risks, including risks of bodily injury, property damage, emotional injury, and other dangers associated
with participation in such activities. Dangers include but are not limited to: strains, sprains, cuts, bruises, broken
bones, concussions, heart attacks, paralysis, brain damage, and even death. Each participant, including spectators, in
sports activities should realize the risks and dangers inherent in such activities and in the training, preparation and
travel to and from such activities. I voluntarily assume all risks, both foreseeable and unforeseeable, arising from my
childs/wards participation with Fusion Academy and Learning Center team sports, whether caused by my or my
childs own actions or the actions of others.
2. Waiver and General Release of Liability: I waive, release, and forever discharge Fusion Academy and Learning
Center, its affiliated companies, board of directors, coaches, volunteers, managers, officials, and administrators from
any and all liability from injuries or damages arising out of or resulting from my childs/wards participation in or
travel to and from any activities associated with the Fusion Academy and Learning Center sports and/or extracurricular program. This is intended as a general waiver and release of all claims, including but not limited to the
negligence or omissions of individuals described above.
3. Emergency Medical Treatment: I authorize the Fusion employees in attendance at any Fusion Academy and
Learning Center activity to select and secure medical attention as may be necessary for my child/ward as a result of
injuries or other events requiring emergency care or first aide while I am not in attendance at such event. Fusion
Academy and Learning Center does not have its own insurance for sports and/or extra-curricular activities. This
agreement waives the schools financial responsibility for accidents related to such student activities.
4. Termination of Participation: Fusion Academy and Learning Center may terminate my childs participation

in any part of or all of a sports and/or extra-curricular activity whenever, in the sole judgment of the school,
continuation of the student's participation would be detrimental to the program or to the interests of the
student.
5. Binding Effect: This agreement shall bind my heirs, representatives, executors, administrators and assigns.
___________________________________________

Date: _____________________________

Students Name

Fusion Academy Morristown

182 South St. Suite 4 Morristown, NJ 07960

973.267.0474

___________________________________________

Daytime Phone _____________________

Signature Parent or Legal Guardian

___________________________________________

Additional Phone ____________________

Print Name of Parent or Legal Guardian

Fusion Academy Morristown

182 South St. Suite 4 Morristown, NJ 07960

973.267.0474