Secondary
School Student Trip Information and Permission Form
Date
of trip: October 28, 2014
Destination:James
Madison University
Educational
Objective(s): To visit James Madison University and see fine arts on a college
campus.
Departure time from
school: 8:00-8:30am
Return time: estimated 1:30pm return
Nonrefundable cost to be incurred by the
student: $20
Nonrefundable cost to be incurred by the attending
adult: $0
Make
checks payable to: Eastern View High School Choral Boosters
Other
important information including: use of electronics, student dress, souvenir
shops, and 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 ___James Madison University in Harrisonburg, VA on ______Tuesday
October 28th, 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_______________
