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Series 604.7.1P Somali - Day Field Trip - Permission Form and Waiver of Liability

 

Shaqaala waxay buuxinayaan bogga 1aad; ku lifaaq macluumaadka/waraaqaha dheerdka ah markii loo baahdo.

 

Gacaliye waalidka/Mas’uulka:

Ardayda fasalka cunugaaga waxay aadayaan rixladda maalinta ah _________________________. Buuxi bogga 2aad

una soo celi foomka __________________________  ugu dambayn _______________. 

Macluumaadka Maalinta Rixladda

Fasal dugsiyeedka/fasalka/macalinka: _____________________________________________

Taariikhda maalinta rixladda: ______________   Waqtiga bixidda:                Waqtiga soo noqodka:                             

Goobta/cinwaanka meesha rixladda loo aadayo:

                                                                                                                                      

 

Sharaxaada rixladda: 

 

 

 

Macluumaad muhiim ah (waa ikhtiyaari):

 

 

 

Macluumaad dheeraad ah oo loogu talagalay waalidka/mas’uulka:

□ Haddii meeshaan ay calaamaysan tahay, waxaa la iska codsanayaa lacag rixladeed oo ah ____ doolar.  Looma diidayo arday inuu ka qayb qaato lacag la’aan darteed; calaamee meesha loogu talagalay ee bogga 2aad haddii cunugaagu u baahan yahay in lacagta laga caawiyo.  Jeega ku qor magaca:                                                                                                 .

□  Haddii meeshaan ay calaamaysan tahay, waxaa loo bahan yahay maalinta rixladda dad caruurta ilaaliya. calaamee meesha loogu talagalay ee bogga 2aad haddii aad doonayso inaad ilaaliye noqotid.

□  Haddii meeshaan ay calaamaysan tahay, goobta rixladda/xarunta waxay doonaysaa inaad buuxiso foomka ogolaanshaha ama midka mas’uuliyad ka qaadka oo halkan ku lifaaqan waana in lala soo celiyaa foomkaan.

 

Waalidka/Mas’uulka buuxi bogga 2aad;  

U soo celi foomka, lacagta, iyo wixii waraaqo dheeraad ah qofka shaqaalaha oo la tilmaamay.

 

Magaca ardayga: _____________________________ Magaca macalinka:                                                

Haddii lacag bixin loo codsaday rixladdaan, fadlan calaamee hal meel:

□         Lacagti way ku lifaaqan tahay. Waxaad ku soo dartaa jeeg oo ku qor magaca dugsiga, lacag cad, ama jeeg bangiga shaabadeeyay.  Haddii aad ku lifaaqayso tabaruc aad ku caawinayso ardayda aanan awoodin in ay lacagta iska bixiyaan, fadlan calaamee meesha loogu talagalay ee hoose taasoo hoos tagta qaybta Jawaabaha Ikhtiyaariga Ah.   

□         Cunugaygu wuxuu u baahan yahay in laga caawiyo xagga lacagta rixladda.

Qofla Lala Xiriiro Haddii Wax Degdeg Dhacaan:

Haddii wax degdeg ay dhacaan waqtiga rixladda, fadlan wac:                                                                    

Ka Qaadidda Mas’uuliyadda

Aniga (waalidka ardayga/mas’uulka ama, haddii ardayga uu jiro 18 sano ama ka weyn, ardayga laftirkiis) waan fahamsanahay in rixladdaan ay tahay mid khatar dhaawac u soo jiidan karta ardayga. Anigoo xor ah waxaan iskay u qaadayaa waxaana u ogolahay khatartaan nafsadayda iyo nafsadda ardayga. Saxiixayga hoos iyo markii la eego dugsiga madaxbanaan ee ddegmada 196 (“Degmada Dusgiga”) oo u ogolaanaysa inuu ardayga ka qayb qaato dhaqdhaqaaqaan, waxaan u ogolahay nafsadayda iyo nafsadda ardayga in aan ka qaadno Degmada Dugsiga, shaqaalahooda, iyo iskaa wax u qabsadayaasha xagga wixii mas’uuliyad ah wixii oo ka imaad kara dhamaan wixii dhaawac ah, naafonimo, ama dhibaato soo gaarta shakhsi ama hanti oo la xiira ka qayb qaadashada ardayga uu ka qayb qaatay rixladda. Mas’ulliyad ka qaadka wuxuu mas’ulliyad ka qaadayaa wixii ku salaysan dayacaad caadi ah, laakim KAMA qaadayo mas’uuliyadda xagga wixii ku salaysan dayacaad guud ama kas ah ama anshax xumo daran. 

U Fasaxid

Saxiixayga foomkaan, Aniga (waalidka ardayga/mas’uulka ama, haddii ardayga uu jiro 18 sano ama ka weyn, ardayga laftirkiis) waxaan u ogolahay ardayga inuu aado kana qayb qaato rixladdaan kor lagu cadeeyay. Waan fahamsanahay in aanan ku qasbanayn inaan inaad u ogolaado ardayga inuu ka qayb qaato rixladdaan, haddii aan doorto in aanan u ogolaan, waxaa laga sugayaa ardayga inuu iskoolka yimaado maalmaha rixladda waxaana la siinayaa dhaqdhaqaaqyo tacliimeed oo macno ku fadhiya waxaana kormeeraya shaqaalaha.

Magaca Waalidka/mas’uulka/Ardayga Qof Weyn ah (Far Ku Qor):                                            

Saxiixa Waalidka/mas’uulka/Ardayga Qof Weyn ah:                                                                     

Jawaabaha Ikhtiyaariga ah:

□          Waan ku faraxsanahay inaan ardayda ilaaliyo; igala soo xiriir taleefankaan ama iimaylkaan wixii macluumaad dheerad ah:                                                                                                     

□          Waxaan ku lifaaqay lacag tabaruc _____ doolar si loo caawiyo ardayda aanan awoodin in ay lacagta bixiyaan.

□        Ilmahayga waxa uu jeclaan lahaa qadada weelka ku jirta si uu ugu qaato dibada la aadayo.

□          Waxaan u qabanqaabinayaa cunugayga gaadiid kale oo geeya kana soo celiya rixladda; inta waxaan ku qorayaa faafaahin si ay shaqaalaha isu qorsheeyaan.

□          Cunugaygu ma imaanayo rixladda wuxuuna u baahan yahay dhaqdhaqaaqyo tacliimeed oo kale inta muddada rixladda.   

Procedure/604.7.1P/3-7-16