Field
Trip Permission Form
Date: October 18, 2007
Dear Parents:
Our class is taking a field trip to Sams Auditorium on Thursday, November 15, 2007. The purpose of this trip is to attend a performance of Ahmahl and the Night Visitors as presented by Southern Crescent Chorale. We will depart from the school at 8:30 am and return to school at 11:30 am.
We are requesting a donation of $5.50 to defray the cost of the trip. This donation is greatly appreciated. The donation is voluntary and no student will be denied participation of the field trip due to non payment. Because these trips depend on your voluntary donations, trips may have to be canceled if donations do not cover the cost of the trip,
We believe that field trips enrich and enhance our instructional program and provide a wonderful educational opportunity for our students. If you wish for your child to participate in this trip, please fill out the information at the bottom and return to your child’s teacher by November 1, 2007. If you do not wish for your child to participate in this field trip, an alternative instructional opportunity will be provided at school. If you have questions or concerns, please contact Mrs. Groover at groover.carolyn@fcboe.org .
Consent, Acknowledgement and Release
_____ My child ______________________ has permission to participate in the field trip.
_____ I have enclosed a donation of _____________ (amount).
Emergency and Medical Information
Emergency Contact 1: _______________________ Telephone: H: _____________ W: ____________
Emergency Contact 2: _______________________ Telephone: H: _____________ W: ____________
List any pertinent Medical History/Medications: ___________________________________________
__________________________________________________________________________________
* In case of
an emergency, I grant permission for school officials to obtain medical
attention for my child.
We understand that the Fayette County Board of Education, its officers, employees and agents do not have or assure any liability for damages, or injuries to the above named student as a result of the student participating in this trip. We understand that unless we have purchased school insurance, there is no school district insurance that may cover any injuries, losses or damages on this trip.
We understand that during this trip, our child will be subject to the policies, rules, and regulations of the Student Code of Conduct and the Fayette County Board of Education. We further understand that during this trip our child is subject to the supervision and the direction of those adults who accompany the students on behalf of the school.
Parent/Guardian Signature: _______________________ Date: __________Telephone: ____________