Secondary School Student Trip Information and
Permission Form
Date of trip: March 13, 2015
Destination: Culpeper County High School
Educational
Objective(s): To compete in the All District 13 Choral Assessment
Departure time
from school: 11:30pm
Return time: 2:30pm
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
County High School on ____March
13, 2015 __ (date).
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_______________
