Roald Dahl’s
The Musical
Who:
All Sixth Grade Students
Where: BROADWAY NYC
When: April 24th
Cost: $40.00
(includes transportation and show)
- The first $20 payment is due December 5, 2012.
- The second $20 payment is due January 8, 2013.
The kids will then need to bring an additional $10 to buy
their lunch at a rest area the day of the trip.
Info:
The students will leave H.M.T.C.A. around 9:30 am. They will
travel by Coach Bus to a rest area and purchase their own lunch
around 11:30 am. They will then travel to the Shubert Theater in NYC.
The play will take place from 2pm to about 5pm. On the bus ride
home students will be given a snack and
their bagged “dinner.” They should return to
HMTCA around 7:45pm for pick up.
If you have any questions please contact Ms. Gomes
at [email protected]
To Change the World it Takes a Little Genius
Hartford Public Schools
Parent/Guardian Information for
Student Field Trip
Dear Parent or Guardian:
Your child is invited to participate in the field trip that is described below. After carefully reviewing the
information provided, please sign the attached permission form for your child to participate. If you do
give permission, you must provide us with answers to the questions on the Permission Form. After
answering the questions, sign and date the form indicating your permission and your agreement with
the information provided, and return it to the contact teacher. If you would like to discuss the field trip
or the form with us, or if you require additional information before making a decision, please call the
contact person listed below.
School: Hartford Magnet Trinity College Academy Contact Teacher: Roxanne Gomes___
Date of Departure From School: __April 24th 2013____ Time: ______9:30 am________
Date of Return To School: _____ April 24th 2013__________ Time: ___7:45 pm________
Destination: ____The Shubert Theater - 225 West 44th Street New York, NY_______
Transportation: ___Premier Bus and Limo Company_______________________________
All trips and activities may involve some risk of injury to children, and we cannot guarantee that no
injuries will occur. This trip will involve the following special activities: [Describe or “None”]
The students will enjoy the Broadway production of Matilda in NYC.
We expect students to behave appropriately during the trip and comply with all school rules. We
reserve the right to exclude your child from the trip in the event of a serious disciplinary offense. We
may require you make arrangements for his or her transportation home if your child disrupts the trip.
The cost of the trip will be $ _____40.00_________ per student.
This amount must be paid by: First Payment due: December 5th ($20)
Second Payment Due : January 8th ($20)
No refunds will be made after __April 1st _____ under any circumstances.
--------------------------------------------------------------------------------------------------------------------
Contact Teacher on Trip: __Roxanne Gomes_______________ Tel. #:__860-695-7248__
Administrator Contact at School During Trip:_ __Sally Biggs ___Tel. #___860-550-3206___
Hartford Public Schools
Parent/Guardian Student Travel Permission Form
Will your child require any special care in connection with this trip? Include a complete description of
your child’s allergies, medication requirements and medical, physical or mental conditions that may be
important in caring for or supervising your child.
None
Yes My child requires special care because of the following:
________________________________________________________________________
________________________________________________________________________
Do any of the special conditions connected with the field trip impact your child?
No
Yes
The following special conditions of the trip are of particular concern because my child (example:
cannot swim, is allergic to poison oak, is afraid of heights, etc)
___________________________________________________________________________________
_________________________________________________________________________
We will contact you immediately in the event of the need for emergency medical treatment for your
child. However, in the event of an emergency before we can contact you, do you authorize us to
provide emergency medical care?
Yes
No
Do you understand, and agree, that all trips and activities involve some risk of injury to children and we
cannot guarantee that no injuries will occur?
Yes
No
Do you understand, and agree, that your child may be excluded from the field trip in the event of a
serious disciplinary violation?
Yes
No
Who may we contact during the period of the trip if we need to notify you of a problem, change of
plans or emergency? Please provide more than one name.
Name: ____________________ Telephone # ____________Relationship__________________
Name: ____________________ Telephone # ____________Relationship_________________
--------------------------------------------------------------------------------------------------------------------I give permission for my child [Name] _________________________________to participate in the
field trip and that the information provided above is true and complete.
Parent/Guardian Name: [Print]_______________________________Date: _________________
Parent/Guardian Signature: _________________________________________________