Secondary School Student Trip Information and
Permission Form
Date
of trip: 12-17-13
Destination:
Farmington Elementary School and Heritage Child Development Center
Educational
Objective(s):To perform at Farmington Elementary School and Heritage Child
Development Center
Departure time from
school: 8:30am Return time: 12:30pm
Nonrefundable cost to be incurred by the
student:0
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:
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 Farmington Elementary School and Heritage Child Dev. Center in
Culpeper, VA on December 17, 2013.
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_______________
