Secondary School Student Trip Information and
Permission Form
Date
of trip: 12-8-14
Destination:
Culpeper Lutheran Church in downtown Culpeper, VA
Educational
Objective(s): To perform for the AARP
Departure time from
school: 11:30 Return time: 2:30pm
Nonrefundable cost to be incurred by the
student: $0
Nonrefundable cost to be incurred by the attending
adult:0
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
11:10 pm to be ready for the bus
departure.
Lunch will be provided through
the AARP. Please pack a lunch if you have specific dietary needs.
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. 8th, 2014.
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_______________
