Field Trip Permission Form

School: _____________________________ School Board: _________________________

Trip to: __________________________________________________________________

Date(s): __________________ Under the Supervision of: ___________________________

Purpose of trip: ____________________________________________________________

ITINERARY  Departure ____________ ____________ ____________ Date Time Place ________________________ ________________________ Method of Travel Planned time of Arrival ________________________________________________________________________ Description of Activities ____________________________________________________________ ____________ Accomodations (if applicable) Phone Return ____________ ____________ ____________ Date Time Place ________________________ ________________________ Method of Travel Planned time of Arrival Parent to Provide Food Yes Volunteers Required Yes No No Cost of Trip $________________________________________________

NOTE: This educational excursion is not compulsory and any student not participating shall attend regular classes.

Please detatch this portion and return to school

Name of Student: _________________________________________________________

Class/Homeroom: ___________________________

is hereby granted my permission to participate in the educational excursion described as:

Trip to: _____________________________________________________________________________

Date(s): ___________________ Under the Supervision of: ___________________________________

Trip supervisors may act as my agent to engage such medical and hospital care as may be required. These supervisors are requested to note the special medical information as follows (or attached):

Emergency Contact Name:______________________________________ Phone:___________________________

Signature of Parent/Guardian _____________________________________ Date:_________________________

If volunteers are needed, would you be willing to help?  

Yes
No

Phone:________________________________