Music Trip Registration Form Please Fill Out The Form Below Student's name * First Name Last Name Student's school email address * Grade 9 10 11 12 Gender (for rooming purposes) Female Male Student's Cell # (required for chaperones during trip) * (###) ### #### Performing Group(s) - Check all that apply * Band Orchestra Choir First Parent's name First Name Last Name First Parent's email Second Parent's name First Name Last Name Second Parent's email Volunteer Information. Please complete this section if you would like to join us as a volunteer. Please note, we may not be able to accommodate all requests. Check below if you are interested in volunteering in one of the following roles: Chaperone Equipment truck driver If you are interested chaperoning, would you like to supervise your child's group? Yes No I'm flexible! Volunteer's name First Name Last Name Volunteer's email Volunteer's cell (###) ### #### Emergency Contact Information. In the event we are unable to reach a parent during the trip, please list an alternate emergency contact Emergency Contact Name * First Name Last Name Emergency Contact Number * (###) ### #### Health Information Please check if your child has a sensitivity to: * Bee sting Nuts Dairy Latex Other No allergies Required medications Please check below if your child has Asthma Diabetes Kidney Injuries Seizure Disorder Heart condition Other Required or other medications Meal Information Does your child have any of the following dietary restrictions? Nut-free Gluten-free Vegetarian Dairy-free Other Other dietary restrictions: Parent Permission To be agreed to by the Parent(s). After reviewing the itinerary, I/We, the parents/guardians of the student named in this form, understand the nature of the trip being planned to Washington D.C, on the dates Friday, March 14th through Saturday, March 15th, 2025, and the cost associated with it ($585). I understand that there are fundraising opportunities available for my student to offset the cost of their trip. We are in accord with the purpose of and procedures governing the trip. We hereby grant permission for our child to participate. We understand that adequate and appropriate supervision will be provided. We recognize, however, that unanticipated situations and problems can arise on any trip, school-sponsored or otherwise, which situations or problems are not reasonably within the control of the supervising teacher(s) or staff (including volunteers). We further agree to release and hold harmless the Town of Wilton and the Wilton Board of Education, their agents, officers, employees, and volunteers, from any and all liability, claims, suits, demands, judgements, costs, interest and expense (including attorneys' fees and costs) arising from such activities, including any accident or injury to the student and the costs of medical services. In the event of any injury requiring medical attention, I hereby grant permission to the supervising teacher(s) or staff (including volunteers) to attend to my child. If the injury warrants further medical attention, I expect every effort will be made to contact me to receive my specific authorization before action is taken. If efforts to contact me are unsuccessful, I grant permission for necessary medical treatment to be given. In addition, I hereby give my permission to the supervising teacher(s) or staff (including volunteers) to take my child to the physician, dentist, or to the hospital if an accident or serious illness occurs on the trip and I cannot be located. In the event that a student must return to Wilton independently for reasons of health, accident, failure to conform to rules established by the teacher in charge, etc., we agree to accept full responsibility for and to pay the cost of medical care, transportation, and other incidental expenses. This permission slip also serves as a contract that the student and parent(s) understand and agree to the guidelines from each teacher as to making up missed assignments. * I/ we agree Behavioural Expectations To be agreed to by the Student. Please review with your child. During the entirety of this trip, students are expected to comply with all school rules and policies contained within the WHS Student Handbook and Student Rights & Responsibilities Handbook, including: No possession, consumption, sale, etc. of any illicit drugs, alcohol, or tobacco. No use of inappropriate language. No student will be permitted to leave the grounds of any event or building. Students will be courteous and compliant at all times, following the directions of directors, administrators and all adults volunteering as chaperones. Students must answer their cell phone if contacted by their chaperone. BUS Stay on your assigned bus. Be on time with boardings. Clean up after yourself. HOTEL Stay in your assigned room - students may not visit any other room. No outside calls or pay TV. No room service or delivery. No excessive noise, running, etc. (many other people will be staying in the hotel). Clean up after yourself I agree to all conditions set here and understand that my parents may be asked to pick me up from Boston in the case of any serious infraction. Student agrees * I/ we agree Bennett Travel Agreement/ Consent I hereby acknowledge receipt of the payment schedule and the cancellation penalty schedule for this trip. Payment Schedule Total Estimated cost: $620 Payment #1 $200.00 10/25/24 Payment #2 $200.00 11/22/24 Payment #3 Balance (approx $220) 01/17/24 All payments must be made by check, payable to: WHS Activity Fund or online (with payment fee). Fundraising proceeds will be deducted from your amount due at each payment. Cancellation / Refund Schedule Now to Oct 25 - No Penalty Oct 26 to Nov 25 - $150.00 Penalty Per Person Dec 26 to Jan 25 - $400.00 Penalty Per Person Jan 26 to Mar 14 - Full Amount Paid Penalty Note: Optional Cancellation Insurance is available at additional cost Cancellation Penalties for Entire Group Now to Oct 26 - No Penalty Oct 26 to Nov 25 - $175.00 Penalty Per Person Nov 26 to Dec 25 - $350.00 Penalty Per Person Dec 26 to Jan 25 - $400.00 Penalty Per Person Jan 25 to Mar 14 - Full Amount Paid Penalty Optional Cancellation Insurance Optional cancellation insurance is available to individuals at an additional cost. This would allow for a full refund of the amount paid for the trip if the individual needed to cancel due to a covered physical illness or injury. Please note that this insurance will not cover a cancellation that is related to a pandemic or an epidemic. Further details about this insurance are available upon request. I hereby acknowledge that I am aware that optional cancellation insurance is available that would provide for a full refund should the student listed above need to cancel his/her trip due to a covered medical reason. I fully understand that it is my responsibility to initiate the purchase of this optional insurance from Bennett Student Travel, Inc. I hereby acknowledge and agree that I will not hold Bennett Student Travel, Inc. responsible for any financial losses should Wilton High School, the school district, and/or its administrators decide to delay, reschedule, or cancel this trip. Parent Agreement to Payment/ Consent * I/ We agree Student and Parent Confirmation By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. Student Signature * Parent Signature * Thank you for filling out the registration form. Please refresh this page if you need to fill the form out for a second student. Remember, $200 deposit either by check or electronically on our music trip page is required!
