student trip form

Kemah Boardwalk Declaration and Order Form
April 26, 2014
Please enlarge this presentation and read it completely before continuing with declaration and orders.
Student's First Name*
Student's Last Name*
My child...*
Will attend the trip to Kemah BoardwalkWill NOT attend the trip to Kemah Boardwalk

Check Out Plans
Please check one*
ROUND TRIP - My child will be riding both ways on the school bus. We will meet him/her at school at 5:00pm.EARLY CHECK-OUT - My child will ride the bus TO Kemah but we will check him/her out after the performance at 11:00am inside the park. He/She will ride home in our vehicle.LATE CHECK-OUT - My child will ride the bus TO Kemah, but we will check him/her out at 3:45pm in the front of the park. He/She will ride home in our vehicle.
Name of the Parent Picking up Child*
Parent Contact Number While At the Park*
Area CodePhone Number
Additional Contact Number
Area CodePhone Number

Volunteer to Chaperone
We need many chaperones for this trip because students will be divided into groups. Mrs. Ramsey will use as many volunteers as possible. However, because students want to be with friends, chaperones will be chosen based on the overall needs of the group. Please select your tickets assuming that you will be selected.
Would you like to chaperone?*
Yes, please!No, thank you.
Chaperone Name

Chaperone Group - enter up to 3 names of students with whom you'd like to be in a chaperone group
Please enter your email address below to receive confirmation of your declaration and order. After clicking "submit" below, please send in your payment and the district permission slip by April 15, 2014. Checks may be made out to Hubenak Elementary.
Confirmation Email Address*

Thank you for your response! We will miss you on this trip! Please click "submit" below.
Should be Empty:

Kemah Boardwalk Declaration and Order Form