Field Trip Permission Form For Parents/guardians Form - Roanoke City Public Schools
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2ROANOKE CITY PUBLIC SCHOOLS
FIELD TRIP PERMISSION FORM FOR PARENTS/GUARDIANS
School___________________________________ Date __________________________________
Class or Group:
___________________________________________________________
Destination:
___________________________________________________________
Departure:
Time: ______________________ Date: _________________________
Return:
Time: ______________________ Date: _________________________
Type of Transportation:
___________________________________________________________
Total Charges/Student:
___________________________________________________________
Type of Supervision:
Members of School staff:
___________________________________________________________
This activity will provide an excellent educational experience for students. In order for your child to
participate, your permission and release from liability are required. Please complete this form (front
and back) and return it to the school along with the appropriate fee by _____________. If you have
questions concerning this activity, please do not hesitate to call the school.
(date)
I agree to release and hold harmless the Roanoke City School Board and its officers, agents and
employees from liability for any accident, injury, illness or death, sustained by the student listed below
in connection with or while participating in this activity.
In the event of any illness or injury, I hereby consent to whatever x-ray, examination, anesthetic,
medical, surgical or dental diagnosis or treatment and hospital care from a licensed dentist, physician
and/or surgeon as deemed necessary for the student’s safety and welfare. It is understood that the
resulting expenses will be the responsibility of the parent/guardian and not the Roanoke City School
Board.
It is important that all families understand that should conditions in our country at the time of the trip
be such that the school administration believes the trip to be an unsafe destination, the trip will be
cancelled. While this would indeed be unfortunate for all involved, we must make safety our first
priority. Should this occur, the money paid for the trip will not be refunded. Most of the cost
associated with the trip must be paid in advance. Therefore, the school will not have the money to
refund. We will make every effort to recoup money spent. However, it is highly unlikely refunds will
be issued.
Please complete the following:
_______________________________ (child’s name) has my permission to go on the field trip to
_______________________________ on ___________________________.
Parent/Guardian Signature: ____________________________ Date: _______________________
Address: ____________________________________________ Phone: ____________________
Student Signature: ____________________________________ Date of Birth: _______________
Please complete the reverse side of this form and return it to your child’s school.
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