UB: Travel Permission & Medical Authorization

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Gulf Coast State College's TRiO Department
Upward Bound Grant Project
Travel Permission & Medical Authorization Form

Instructions:

This form must be submitted by a Parent/Guardian for an Upward Bound participant to travel with Gulf Coast State College's TRiO department to the University of West Florida (11000 University Pkwy, Pensacola, FL) on Wednesday, April 15, 2026. Please read this document carefully and complete all required sections. If you have any questions, please email TRiO@GulfCoast.edu, call (850) 769-1551 x3397, or visit us at Room 89 of GCSC's Student Union West building. Students/participants cannot complete this form on behalf of their parent(s)/guardian(s)!

I. Student/Participant Information:

Student's first name:

Student's last name:

Student's date of birth:

Student's cell phone number:

II. Parent/Guardian Information:

What is your First Name?

What is your Last Name?

What is your Cell Phone number?

What is your Email Address?

III. Acknowledgments:

A) I acknowledge that I'm the parent or guadian of the student/participant detailed above and grant permission for them to participate in this event—including travel and educational activities.

B) I understand that transportation may be provided by TRiO using chartered buses, GCSC-owned vehicles, or other approved vendors/providers. I acknowledge that participation in travel and related activities involves inherent risks—including but not limited to transportation-related incidents, weather conditions, and general travel risks. To the extent permitted by law, I voluntarily assume these risks on behalf of my student/participant.

C) In the event of an emergency, I authorize Upward Bound staff or their designees to obtain emergency medical treatment for my student/participant if I cannot be reached in a timely manner. I understand that reasonable efforts will be made to contact me prior to such treatment. I acknowledge that I am financially responsible for any medical expenses incurred as a result of such treatment.

D) I agree to disclose any medical conditions, allergies, medications, or accessibility needs that may affect my student’s/participant's participation in this activity, and I understand that failure to disclose relevant information may limit Upward Bound’s ability to provide appropriate accommodations or respond effectively in an emergency.

E) I understand that my student/participant is expected to comply with all Upward Bound rules, institutional policies, and staff instructions at all times. I acknowledge that serious misconduct may result in my student being sent home at my expense and/or disciplinary action consistent with Upward Bound's Participant Handbook.

F) To the fullest extent permitted by law, I agree to release, indemnify, and hold harmless Gulf Coast State College, TRiO, Upward Bound, its trustees, officers, employees, and agents from any claims arising out of my student’s participation in this activity, except to the extent caused by gross negligence or willful misconduct.

IV. Parent/Guardian Signature:

Type your full name here to electronically sign this Travel Permission & Medical Authorization form.

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