Peoria Unified School District #11
FIELD TRIP PERMISSION FORM
STUDENT’S FIRST NAME
STUDENT INFORMATION
STUDENT’S LAST NAME
DATE OF BIRTH (MM/DD/YYYY)
MAILING OR STREET ADDRESS/APT#
HOMEROOM TEACHER
CITY AND ZIP CODE
ROOM #
GRADE
FIELD TRIP INFORMATION
DATE OF FIELD TRIP
FIELD TRIP DESTINATION
DEPARTURE TIME FROM SCHOOL
RETURN TIME TO SCHOOL
EMERGENCY CONTACTS
For precautionary measures, please provide us your phone number at home OR the phone number where
you may be reached on the day of the field trip. In addition, please provide us one or two other contacts (a relative, friend, or sitter, etc.)
and their phone numbers in case of an emergency.
NAME OF PARENT/GUARDIAN TO CONTACT
PHONE NUMBER OF PARENT CONTACT
INDICATE PHONE # TYPE
HOME
WORK
CELL
NAME/RELATIONSHIP ADDITIONAL CONTACT
PHONE NUMBER OF CONTACT
INDICATE PHONE # TYPE
NAME/RELATIONSHIP ADDITIONAL CONTACT
PHONE NUMBER OF CONTACT
INDICATE PHONE # TYPE
HOME
HOME
WORK
WORK
CELL
CELL
MEDICAL INFORMATION
NAME OF MEDICAL INSURANCE PROVIDER
INSURANCE NUMBER
SPECIAL MEDICAL INSTRUCTIONS TO FOLLOW
DATE OF LAST TETANUS
MEDICATION ALLERGIES (LIST ALL)
Check here if your child MUST take medication with him/her. If so, please have the student check with the school nurse to obtain the
consent form.
PUSD SPONSORED TRAVEL
Water facility usage is permissible while traveling if activity is staffed with certified lifeguards.
STUDENT’S SWIMMING ABILITY STATEMENT - REQUIRED if traveling to Water Facility
There are inherent risks in using water facilities. If you choose to have your child participate, you accept those risks.
By marking one of the boxes below, you are indicating your child’s ability to swim or to be near any pool of water:
NONE AND SHOULD NOT BE NEAR ANY AMOUNT OF WATER
BEGINNER LEVEL AND STILL NEEDS CLOSE SUPERVISION WHILE IN THE WATER
INTERMEDIATE LEVEL WITH SUPERVISION WHILE IN THE WATER
ADVANCED SWIMMER WITH LITTLE SUPERVISION NEEDED IN THE WATER
PARENT SIGNATURE REQUIRED
to attend the field trip that has been scheduled. If any illness or injury occurs, I
I allow
authorize a school representative to obtain emergency treatment for the above student and the closest medical facility unless
instructed otherwise by paramedics or according to the special instructions listed above.
PARENT/GUARDIAN SIGNATURE FOR FIELD TRIP
DATE
PARENT/GUARDIAN SIGNATURE FOR EMERGENCY MEDICAL TREATMENT
DATE
6/1/2014 12:40 pm k-12
Peoria Unified School District #11
RULES AND REGULATIONS for Water Park Field Trips
The following list of rules and regulations that students who are on a field trip to a water park are expected to follow at
all times during their visit. Failure to comply with the park’s Rules & Regulations may result in removal from the park
without refund. For a complete list of park rules and regulations, visit Guest Services which should be located at the
park’s main gate.
Note: the following items marked with an asterisk are specific to the Wet ‘n’ Wild Water Park.
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Read and obey all posted rules and instructions given by the park staff.
Appropriate bathing suits are required. No shorts, cutoffs, or items with metal fasteners, rivets, zippers or
buckles are allowed on the slides.
For all guests, smoking is only permitted in the designated area outside the main gate.
Containers, food, drinks or picnic lunches may not be taken into the park. Guests with special diets, baby
formula or baby food may bring their items in to the park.
All bags, backpacks, and packages are subject to inspection prior to entering the park. As a reminder, for the
safety of our guests the following items are not permitted inside the park: Weapons, sharp objects, hazardous
items or materials, or any other item that may be perceived as a weapon.
In keeping with the family atmosphere of the park, inappropriate actions such as offensive or profane language
and/or gestures as well as unruly behavior including horseplay will not be tolerated.
Please shower prior to enjoying the pools and attractions.
Some facilities may have additional participation guidelines relating to health, physical ability, etc.
PARTICIPATE SAFELY
 As a guest, you are responsible for your own safety. Instructional signage is posted at each attraction. Please
listen to and obey all lifeguard instructions. Please read and follow all posted safety information. Inappropriate
or unsafe behavior will not be tolerated and is subject to immediate removal from the Park without refund.
 We encourage the use of a “buddy system” for large groups.
 Establish a “home base” at the Park for students to know school staff location.
 Attraction height and weight restrictions as well as child life vest requirements apply on certain attractions.
 Running and horseplay are not permitted.
 It is strongly recommended that all weak or non-swimmers wear a Coast Guard approved life vest.
Complimentary life vests are available. Please see a lifeguard for assistance. Floaties, water rings, and other
floatation devices are not permitted. Only Park issued rafts are permitted. Water wings, masks, snorkels, and
other SCUBA equipment are not permitted. Coast Guard approved “puddle jumper” style floatation devices are
permitted for use.
 * Many rides at Wet ‘n’ Wild are dynamic and thrilling and may include features such as high speeds, steep
drops, sharp turns, and other forces. There are inherent risks in participating in any amusement attraction. If
you choose to participate, you accept these risks.
Zero tolerance policy
Actions, language, behavior or conduct that interferes with a family atmosphere will result in the ejection of the
offending person without refund or any other compensation. This includes, but is not limited to: offensive clothing,
profanity, vulgar gestures, running, spitting, fighting and line breaking.
Holding a place in line is not permitted. If you leave the line for any reason, you will lose your position and will need to
start at the end.
6/1/2015 12:40 pm k-12