Health Science Program Transportation and Release of Liability Form It is understood the Health Science Program Hospital Rotations/ Clinical Observations is a learning opportunity that is an extension of the classroom setting which allows the student to participate in clinical observations as an unpaid student observer. I/we agree to release and hold harmless the Denton Independent School District, Health Science Program, and participating health care facility from any and all liability, including negligence, should the student be injured during or in transit to and from the hospital, observation site, or ATC campus. I/we understand that the health care facility is not an employee or agent of the Denton Independent School District and the Denton Independent School District is not an insurer of the safety or conditions of the health care facility. Denton ISD and Health Science Program needs permission to allow your child to participate in the hospital rotations/clinical observations, travel to and from the ATC campus, and travel to and from the hospital/clinical observation site. A signature indicates you have read and understand all of the above information. ___________________________________________________ Student name (print name) _________________________ Student ID # ___________________________________________________ Student signature ________________________ Date ________________________________________________ Parent/Legal Guardian signature ________________________ Date 9/15 Denton ISD does not discriminate on the basis of race, religion, color, national origin, sex, or disability in providing education or providing access to benefits of education services, activities and program, including vocation programs, in accordance with Title VI of the Civil Rights Act of 1964, as amended: Title IX of the Educational Amendments of 1972; Section 504 of the Rehabilitation Act of 1973, as amended; and Title II of the Americans with Disabilities Act. Inquiries regarding these policies should be directed to the Executive Director of Human Resources (940) 369-0000.