Field Trip Permission Form
Child's Full Name
First Name
Last Name
Destination
Date of Trip
-
Month
-
Day
Year
Date
Departure and Return Time (Estimated)
Hour Minutes
AM
PM
AM/PM Option
&
until
Hour Minutes
AM
PM
AM/PM Option
Departure/Return Site
School
Class
Advisor Name
First Name
Last Name
Price
Mode of Transportation
Purpose of Trip
Specific Activities Planned
I, the parent/guardian of the student named above, agree with the following statements:
I hereby give permission for my child to take part in the trip described above.
I understand that I am responsible for getting my child to and from the departure and return sites identified above. I understand that my child shall be accompanied by staff member(s) during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site.
I understand that my child is expected to behave responsibly and to follow the school’s discipline code and policies.
I agree and understand that I am responsible for the actions of my child, and I release the school from all claims and liabilities that arise in connection with the trip, except if due to the negligence of school officials.
I confirm that my child is medically fit and able to participate in all activities described above.
I understand that as a parent, if I believe it is necessary to limit my child’s activity to a great extent, then the school may not be able to accommodate my child on this trip and that I and my child will be informed of this decision as soon as possible upon the receipt by the school of this completed consent form.
I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child.
I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child. I understand that if my child is found in possession of these substances, he/she will be subject to school disciplinary procedures and possible criminal prosecution.
I understand that students who violate the school’s discipline code may be excluded in the future by the school from participating in a school trip.
I have indicated below any permanent or temporary medical or other condition(s) including special dietary and medication needs, or the need for visual or auditory aids, which should be known about my child: (please write "N/A" if this does not apply to your child)
Emergency Contact Name:
First Name
Last Name
Phone Number (1)
Format: (000) 000-0000.
Phone Number (2)
Format: (000) 000-0000.
Additional Contact
First Name
Last Name
Phone Number (1)
Format: (000) 000-0000.
Phone Number (2)
Format: (000) 000-0000.
Children must bring a disposable lunch (no glass bottles) labeled with his or her name. If it is a hardship for you or you are unable to provide lunch for your child on the day of the trip, please let us know ASAP so we can arrange to get a bagged lunch from the cafe.
I will provide a disposable lunch for my child on the day of the trip.
I will NOT be able to provide lunch for my child on the day of the trip and will need a bagged lunch from the cafe.
Are you interested in joining us as a chaperone? (We are limited to only a few chaperones per trip so we will confirm with you once we receive responses. Also, please note that chaperones will be responsible for paying all trip fees).
Yes
No
Name of Parent/Guardian
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Signature of Parent/Guardian
Submit
Should be Empty: