Secondary
School Student Trip Information and Permission Form
Date
of trip: 12-12-13
Destination:
Best Western Hotel
Educational
Objective(s): To perform for the Culpeper Retired Teachers Luncheon
Departure time from
school: 11:30am Return time: 1:30pm
Nonrefundable cost to be incurred by the
student: $5 transportation/lunch at restaurant
Nonrefundable cost to be incurred by the attending
adult: $0
Make
checks payable to: EVHS Choral Boosters
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
11:10am to be ready for the bus departure.
Students need to bring money in
order to get lunch at McDonalds.
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. 12, 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_______________
