Secondary School Student Trip Information and
Permission Form
Date of trip: February 22, 2013
Destination: Powhatan High School
Educational Objective(s):
To compete in the Powhatan Show Choir Classic Competition
Departure time
from school: TBA
Return time: TBA
Other important information including: use of
electronics, student dress, souvenir shops, supplies needed:
See information sheet
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
_____Powhatan High School in Powhatan, VA
on ______Feb. 22, 2013__ (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_______________
