I
FIELD TRIP PARENTAL PERMISSION FORM
TRIP FORM
ALEXANDER CITY BOARD OF EDUCATION
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
~I •••••••
['ate
$chool/Department
To:
Parent(s)/Guardian(s)!Custodian(s)
From:
your Child's Teacher/Coach/Sponsor
A school activity has been planned away FROM SCHOOL. The specific lnformatlon
·····,
~---~-
relative to the activity is
listed below:
Proposed School Activity_~-----
_
of Activity
Date(s)
~
Name of Person(s) in Charge
Trip Destin~tion(s)
Departure
Cost
_~
_
~~~
_
~_-----------~~------
Time
_
---------Expected
Time of Return
to Your Child $
_
[Mak ~ checks payable to the school)
Type of Transportation:
School Bus-------..i Commercial
Carrier __
i Private \ ehlcle: Walking
THIS FORM MUST BE RETURNED TO THE PERSON IN CHARGE BY
••
~.7.7.~
..~.~.~.~.~.~lill~
a •••••••••••••••••••••••••••••••••••••••••••••••••
_
~....•...•.... l
THIS SECTION TO BE COMPLETED BY PARENT/GUARDIAN/CUSTODIAN
My child may
_
may not
participate
in the above naried
If you approve of your child making the trip based on the information
needed information
asked for below, sign your name in the space provided,
provided
and return this form
your name in the space
by your child to the person(s) in charge.
In case of an emergency,
the nearest emergency
above, please fill in the
nnd return this form by your child
to the psrsonts) in charge. If you do not wish for your child to make the trip,.ign
provided,
activity.
my child may
medical treatment
receivf> medical treatment
may not
facility. (Any emergency
medical t'eatment
at
shall be at the expense
of the psrent/guardlan/custodlan.)
My child is covered by medical insurance.
If Yf>S,please list the name of insurance
Policy #
Parent/Guardian/Custodian
yes
No
carrter and policy number: Carrier
_
Signature
Date
NCJt~:Children will not be permitted to go onfteid trips without a slgn~d "eld irlp POfl,nt,CJI P(!,rmis,ioflForm on fil~ J " ~C/cl1 trip or ossociated series of trips such as
bo~k~tboll, etc. (If a series of activities (athletic <;Iame5, etcI ottocb schedule of "c(!vItle5 to t!lisform,
[ootbot',
_