Secondary School Student Trip Information and
Permission Form
Date
of trip: 12-12
Destination:
Best Western Hotel
Educational
Objective(s): To perform for the Culpeper Christian Women’s Club
Departure time from
school: 9:20 Return time: 11:30
Nonrefundable cost to be incurred by the
student: lunch at restaurant
Nonrefundable cost to be incurred by the attending
adult:0
Make
checks payable to:N/A
Other
important information including: use of electronics, student dress, souvenir
shops, supplies needed:
Students
need to be dressed in their proper outfits and shoes for this performance. Students need to report to the choir room at
9:10 to be ready for the bus departure.
Students need to bring money in
order to get lunch at McDonads
Keep the top half for your
information. Return the bottom half to
the appropriate teacher or staff member.
.
Please
list any serious allergies or medical
conditions of your child:
_______________________________________________________________________.
My child, ______________________________ has permission to attend
the trip to __________________ Best Western______________in Culpeper, VA on ______Dec.
12th__________ (date).
I give prior permission for
any emergency medical treatment of my child where a delay could cause
significant harm to his or her health.
________________________________ __________
Parent/Guardian’s Signature Date
Parent
and Emergency Contact Name__________________________ or __________________________
Phone
Numbers: ________________ or ___________________ or_______________
