Daycare Field Trip Permission Slip Form
Please complete this form to give permission for your child to attend the daycare field trip and to share the information staff needs for safe supervision.
Child and Parent/Guardian Information
Child's Full Name
*
First Name
Middle Name
Last Name
Child's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Classroom / Group
*
Please Select
Infants
Toddlers
Twos
Preschool
Pre-K
Other
Parent / Legal Guardian Full Name
*
First Name
Middle Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Legal Guardian
Grandparent
Foster Parent
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency and Pickup Authorization
Emergency Contacts
*
Authorized Pickup Persons
*
Pickup Restrictions or Unauthorized People
Primary Emergency Contact Full Name
*
First Name
Middle Name
Last Name
Primary Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Emergency Contact Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Field Trip Details and Child Needs
Field trip name or destination
*
Trip date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Departure time
*
Hour Minutes
AM
PM
AM/PM Option
Return time
*
Hour Minutes
AM
PM
AM/PM Option
Transportation method
*
Please Select
School bus
Walking
Public transit
Parent/guardian vehicle
Other
Classroom or teacher leading the trip
*
Child allergies, medical conditions, medications to be administered during the trip, dietary restrictions, mobility/support needs, and any special instructions for staff
Additional safety or supervision notes
Permission and Acknowledgment
Parent/Guardian Signature
*
Date Signed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Permission
Submit Permission
Should be Empty: