12201 New Hampshire Avenue
Silver Spring, MD 20904
301-288-8200
FAX 301-989-5696
Field Trip Parent Permission Slip
Cost: $24.00
Who: All 7TH Grade Students
When: Tuesday, May 31, 2016
Where: Smokey Glen Farm
Purpose of Trip: Students will be able to participate in an outdoor end of the year
celebration incentive based field trip.
Payment Due Date: Friday, May 20, 2016
Payment Includes: Lunch and activities
I give permission to my child _________________________________ to participate in this field
trip. In addition, if necessary I give permission to White Oak Middle School to provide emergency
medical treatment for my child on my behalf. I also understand that if my child exhibits
inappropriate and/or disruptive behavior during the weeks prior to the trip, my child may be
not able to attend the field trip.
Parent/Guardian Signature ______________________Work/Daytime Phone ____/____-______
Field Trip Payment
Student Name _________________________________________________________
Check a Method of Payment: Cash______/Check/Check No.___________ Online___________
Waiver Needed? ____ Parent signature required ________________Parent contact#_____
Field Trip Donation (Optional) Cash______/Check No. ______Date Collected: _______
Note: If it is not necessary for WOMS to use your donation for this specific Field Trip, may we retain your
donation to support future student scholarships. ____Yes/____No.
Teacher Signature__________________________________________ Date__/__/____
*All Payments are final and non-refundable
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Office Use _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Field Trip Payment
Student Name __________________________________Cash_______/Check/Check No._______
Waiver_________
Online _____________
Field Trip Donation (Optional) Cash______/Check No. ______Date Collected: _______
Note: If it is not necessary for WOMS to use your donation for this specific Field Trip, may we retain your
donation to support future student scholarships. ____Yes/____No.
Teacher Signature__________________________________________ Date__/__/____
Student Receipt Copy
*All Payments are final and non-refundable