MHS Field Trip Permission Form

FIELD TRIP PERMISSION FORM

I hereby give permission for my child, __________________________________ to participate
in the activity on (Date:) __________________________________ described below.
Description of activity: _______________________________________________________
Should a medical energency arise on the trip, I give my permission for my child to receive appropriate medical treatment.

Home Telephone: __________________ Daytime Telephone: __________________

Emergency Contact: __________________________ Relationship: _______________

Emergency Contact Telephone: ________________________________________

Medical problems of which chaperone should be aware: _____________________________

____________________________________________________________________________

Parent/Guardian Signature: ________________________________________

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Parents/guardians, please keep this portion as a reminder of trip.

Date of Trip: ___________________ Teacher's Name: ___________________

Departure Time: ___________________ Return Time: ___________________

Transportation: ___________________ Items to Bring: ___________________


Emergency Contact:	__________________________	Relationship:	_______________


Emergency Contact Telephone:	________________________________________


Medical problems of which chaperone should be aware:	_____________________________


Parent/Guardian Signature:	________________________________________


Date of Trip:	___________________	Teacher's Name:	___________________
Departure Time:	___________________	Return Time:	___________________
Transportation:	___________________	Items to Bring:	___________________