Secondary School Student Trip Information and
Permission Form
Date of trip:April 10th, 2014
Destination: State Theatre Culpeper
Educational
Objective(s): To rehearse for the evening concert.
Departure time
from school: Electrified- 9:35, Artistic- 11:20, Innovation- 1:35pm
Return time: Electrified-11:10pm,
Artistic-1:30pm, Innovation- 2:45pm
Other important information including: Please
bring all dress bags to be put away at the state theatre.
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 practice at
the State Theatre on April 10th at the specified time
above. Students will only miss their choir class for this trip.
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_______________
