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.
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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_______________