4531-E.2.1

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PERMISSION OF PARENT/GUARDIAN FOR AN EXTENDED FIELD TRIP

Each student must secure the permission of his/her parent or legal guardian in order to participate in a school –sponsored extended field trip. Additional instructions or comments specific to this extended field trip are attached.
 
Parents or legal guardians are required to complete, sign and return all parts of this approval and medical release, emergency information and health information forms and return it to their child’s teacher at lease one (1) week prior to the departure date of the extended field trip.

PERMISSION OF PARENT OR LEGAL GUARDIAN
 
STUDENT’S NAME …………………………………………….
 
The undersigned, parent or legal guardian of the student named above, grants permission for him/her to participate in an extended school-sponsored field trip as noted below.
 

DEPARTURE DATE…………………………………..DEPARTURE TIME …………………………..
 
RETURN DATE………………………………………. RETURN TIME: ……………………………….
                   (Approximate)
SCHOOL DISTRICT STAFF PROVIDING SUPERVISION:
 
…………………………………………………    ………………………………………………
 
…………………………………………………    ………………………………………………
 
Will your child require any form of medication to be taken
while s/he is on this extended field trip ? (circle one)      Yes    No
 
If YES, please contact the school nurse at once so appropriate and timely arrangements may be made with you for the proper handling and administration of your child’s medication during the extended field trip.
 
Do you have cancellation insurance in force for this trip ?    Yes    No
 
If NO, please sign below to waive said coverage and relieve the school district of any liability with regard to cancellation of the extended field trip.
 
Date.,…………………………. Signature ………………………………………………………………….

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