Field Trip Permission Form - Noblesville Schools printable pdf download

FIELD TRIP PERMISSION FORM

I hereby give permission for my child to participate in the educational, athletic, or extra-

curricular field trip described below. During such event, if it shall be necessary for my child to

receive medical treatment for any illness, injury, or emergency, I authorize the school, or any of

its agents, employees, or volunteers, to secure reasonable medical treatment for my child and I

hereby appoint such representative of Noblesville Schools to consent for all medical and/or

surgical treatment and/or medical procedures which may be required in the event of an

emergency. I understand that if time permits, I will be consulted and advised of the situation,

and this authorization is used only in the event of an emergency.

Date of event: _________________________________________________________________

Description of event:____________________________________________________________

Estimated departure time from school: ______________________________________________

Estimated return time to school: ___________________________________________________

Name of student: ______________________________________________________________

Parent/Guardian phone:______________(home)_______________(work)______________(cell)

____________________________________________

______________________

Date

Parent / Guardian

In conjunction with the event described above, I am hereby providing the school with the

following information regarding my child.

In case of emergency, and the parent or guardian cannot be located, please call the

following individual:

Name: _______________________________________________________________________

Phone:___________________(home)___________________(work)__________________(cell)

Allergies of child: _____________________________________________________________

_____________________________________________________________________________

Physical disabilities of child: ____________________________________________________

_____________________________________________________________________________

Prescription or other medication required, and times to be given: ________________________

_____________________________________________________________________________

Other comments:______________________________________________________________

_____________________________________________________________________________

THE FIELD TRIP PERMISSION FORM

MUST BE IN THE POSSESSION OF THE STAFF MEMBER IN CHARGE

OF THE FIELD TRIP IN CASE OF AN EMERGENCY

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Field Trip Permission Form - Noblesville Schools