MEDIEVAL TIMES
6th Grade Field Trip
Permission Form/Waiver
Where:
When:
Leave DIS:
Return to DIS:
Cost per student:
Medieval Times Dinner & Tournament – Dallas
Friday, January 27, 2017
9:15 a.m.
1:30 p.m. (approximately)
$40.00 (Includes transportation, meal, souvenir banner, entertainment and gratuity)
Vegetarian or gluten-free meal available upon request. Log on to www.medievaltimes.com/dallas.aspx
for more information.
Completed Waiver and Money DUE: DECEMBER 1, 2016
You may pay with cash, check, or online using the Ticket Tracker link below from Nov. 1st through Dec. 1st .
Log on to www.ticketracker.com. Type in Durham Intermediate; click Field Trip Fees; Click Medieval Times.
Chaperones (Chaperones must PAY BY CASH OR CHECK made payable to DIS)
Because of limited seating, we will be allowed 4-6 chaperones per homeroom. Please supply the
requested information at the bottom of this form if you wish to be considered. Chaperones will be
selected on a first come, first served basis. Payment for chaperones is $35.00 and will be due upon
notification. Chaperones must be on the Approved Volunteer list. To become a volunteer/chaperone,
visit www.southlakecarroll.edu and complete the Volunteer application (go to Parents and Volunteer
Program). Chaperones will provide their own transportation, either following the DIS buses or meeting
at Medieval Times. As always, chaperones must account for their assigned students at all times.
Curriculum
Following are the Texas Essential Skills and Knowledge (TEKS) that relate specifically to this social studies unit.
6.1 HISTORY - The student understands that historical events influence contemporary events.
6.1B ANALYZE the historical background of various contemporary societies to evaluate relationships between past conflicts
and current conditions.
6.2 HISTORY -The student understands the influences of individuals and groups from various cultures on various historical
and contemporary societies.
6.2A DESCRIBE the influence of individuals or groups achievements on various historical or contemporary societies.
6.2B EVALUATE the social, political, economic, and cultural contributions of individuals and groups from various societies,
past and present.
6.12 GOVERNMENT – The student understands various ways in which people organize governments.
6.12A IDENTIFY and give examples of governments with rule by one, few, or many
Please provide the requested information if you wish to be considered as a chaperone.
I wish to chaperone the field trip January 27, 2017 ________________________________________
(Please print name clearly.)
Child’s name: ___________________________________________________________________
Phone Number _______________________ Email ________________________________
(Please print clearly.)
FOR TEACHER USE:
Date returned: __________________________________
Durham Intermediate School
Student Waiver
I grant permission for my child (please print name clearly) ___________________________________
to participate in and attend the following school sponsored activity:
Date:
Friday, January 27, 2017
Activity: Medieval Times Dinner & Tournament in Dallas, Texas.
•  I would like to preorder a special meal for my child: (Please circle).
Vegetarian
Gluten Free
__________________________________________________________________________________
• I understand that on a school sponsored trip, my child will be accompanied by and under the direct
supervision of school personnel.
• I agree that the school and/or school personnel are not to be held liable for damages caused by my
child or any accident or injury to my child.
• I authorize Carroll Independent School District to seek emergency medical attention for my child in the
event I (the parent or guardian) cannot be reached.
Please print your name clearly.
Address
Home telephone
Insurance Company
Parent/Guardian’s signature
City
State
Work telephone
Zip Code
Cell telephone
Policy and/or Group Number
Please indicate any allergies, medications, special instructions, etc.
**PLEASE NOTE**
•  Medieval Times is a live horse show in an enclosed arena. Persons with respiratory conditions, allergies,
or asthma attend at their own risk.
•  Medieval Times uses stroboscopic and pyrotechnic effects.
•  Dessert & garlic bread may have come in contact with nut or nut products.
Durham Intermediate School 803 Shady Oaks Drive Southlake, Texas 76092 817-949-5300