Secondary School Student Trip Information and
Permission Form
Date
of trip: March 11th, 2015
Destination:
Culpeper Presbyterian Church
Educational
Objective(s) to perform for the lent church service
Departure time from
school: 11:30am
Return time: 1:30pm
Other
important information including: use of electronics, student dress, souvenir
shops, 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 Culpeper Presbyterian on April 9th.
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_______________
