Aga Khan Academy Nairobi, Senior School

Aga Khan Education Service, Kenya

SCHOOL TRIP CONSENT FORM

Student’s Name: ___________________________ Parent / Guardian Name: __________________________

Parent’s Contact Number: _________________________Parent’s Email: ______________________________

I, __________________________________being the parent/lawful guardian of___________________________

give consent for my son/daughter in grade ________________ (“STUDENT”) to attend and participate in a school-organised
trip to _________________________________ and take part in various activities.

STUDENT INFORMATION:

Allergies: ______________________________________________________________________________

Any diabetes/asthma/epilepsy? _____________________________________________________________

Medication: _____________________________________________________________________________

Dietary Requirements: ______________________________________________________________________

Recent Illness: _____________________________________________________________________________

Medical Insurance Cover name and no. (if any): ___________________________________________________

ACKNOWLEDGEMENT OF RISK & WAIVER OF LIABILITY & INDEMNITY

This consent is given voluntarily, and it is acknowledged that school trips have certain inherent risks which cannot be
eliminated due to the unique nature of the activity. Therefore, whilst every precaution will be taken to prevent injuries and
accidents, it is understood and accepted that The Aga Khan Academy Nairobi, Senior School (“SCHOOL”) will not be held
responsible for any damage or injuries which may be suffered by the STUDENT during the course of this trip.

I agree, in my capacity as a parent/legal guardian of the above-named STUDENT, to release the SCHOOL, its staff and
administration, including Aga Khan Education Service, Kenya (AKES-K) from all liability and responsibility for any loss, injury,
harm or damage that might occur and be sustained by the above-named STUDENT for the duration of this trip. I further waive
all rights to legal recourse against the SCHOOL and AKES-K for any events that may occur during this trip. By signing this
form, I also agree to indemnify the SCHOOL and/or its duly authorized agents for all costs and claims arising from any loss,
damage, injury or death or injury to any persons or property. I further agree that in the event of injury or illness to the
STUDENT, I hereby authorize the SCHOOL and its personnel to obtain, manage, provide or to take the STUDENT to or to
the nearest medical facility for any emergency medical treatment or procedure and I agree to bear full responsibility for and to
indemnify them for all and any costs of medical treatment undertaken by the SCHOOL or its personnel to care for the
STUDENT’s health and well-being.

Date: ________ day of the month of ______________ 2024

Name of Parent: _______________________ Signature: ________________________

Passport Type/No or ID No. ________________________

Name of Witness_______________________________ Signature ___________________________