Coffee County Central High School

Interact Club River Clean Up Permission Form

Please print off and fill in this permission form.

Your child’s will be taking a field trip with Interact Club to:

Location: / Pepper Branch Park, McMinnville, TN
Mode of Transportation / Private vehicle – May ride with Ms. Perry or another sponsor if a ride is needed
When /

Date Saturday July 18th, 2015

/
Time /

Meet at CCRA @ 7:00 am SHARP to car pool (must be in McMinnville @ 7:30, and it’s a 30 min drive). We will return around Noon.

/
Cost / FREE!!! (breakfast, lunch, water, kayaks, lifejackets, paddles, gloves, and trash bags included) /
Additional Information / You may contact your child for an emergency using this number 931-980-4154 (Ms. Kandace Perry)

Important: Please keep the top portion of this field trip permission form for your records.

#CUT HERE ------#CUT HERE ------#CUT HERE ------#CUT HERE ------#CUT HERE

Please return this portion of the field trip permission form to Ms. Perry the morning of the trip.

I give my child,

permission to attend the field trip to

on from to .

I give permission for my child to receive emergency medical treatment. In case of emergency, please contact

Name

/ Phone Number
1.
2.
3.

My child has special dietary or medical needs such as:

My child and I are familiar with the Coffee County School Board Code of Conduct and are in agreement that he/she will abide by all rules and regulations while attending this school function.

Parent’s/Guardian’s Signature Date

Parents are welcome and encouraged to participate in field trip activities.