Secondary School Student Trip Information and
Permission Form
Date of trip: May 3, 2013
Destination: Kings Dominion
Educational
Objective(s): To compete in the Kings Dominion Music Festival 2013
Departure time
from school: 9:00am
Return time: 10:30pm
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 __Kings
Dominion in Doswell, VA on ____May 3,
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_______________
