Secondary School Student Trip Information and
Permission Form
Date
of trip: 5-5-15
Destination:
Best Western Hotel
Educational
Objective(s): To perform for the Culpeper Retired Teachers
Departure time from
school: 12:15 Return time: 1:45pm
Nonrefundable cost to be incurred by the
student:None
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
11:45pm to be ready for the bus departure.
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 May 5th, 2015.
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_______________
