Big Trip Excursion Authorization for UE

My child has my permission to travel with The Children's House at Serenbe adult chaperones to Birmingham, AL from May 12 to May 15 for their Big Trip and participate in related activities and excursions.

I understand that every effort will be made to contact me in the event of an emergency. In the case of a medical emergency, I hereby authorize THE CHILDREN'S HOUSE AT SERENBE to transport my child to the nearest hospital and/or medical treatment facility to secure the necessary medical treatment. I understand there will be staff traveling with my child who are current in their certification for basic first aid and CPR, and authorize them to give my child first aid where/when appropriate.

Please provide medical insurance insurance information:

Does your child have medical insurance? *
Child's Full Name *
Child's Full Name
Name/ Number
Name/Number
Describe. All medications will need to be given to Miss Lisa to retain and administer. Please describe administration needs.
Date *
Date