Latest Revision 5-08
ALEXANDER COUNTY SCHOOLS
FIELD TRIP INFORMATION/PERMISSION SLIP
Dear Parent,
A field trip has been planned that will serve as an enrichment experience for those students participating. The trip will serve as a preparatory/follow-up activity to enrich a regularly scheduled part of the instructional program. Students will not be allowed to take the trip unless parental permission is granted. All lines on the Parental Consent form (below) must be completed. If you do not have a doctor, insurance, cellular phone, etc., please fill in the blank with the word “none”.
The behavior of our students as it relates to a field trip is of critical importance. Students are always expected to be on their best behavior. Inappropriate behavior will result in disciplinary action, including in extreme cases being returned home separately at the parent’s expense.
The Following Details Are Provided For Your Information:
DESTINATION: Dan Nicholas Park, Salisbury, NC 28146
SUPERVISING TEACHERS: Donna Abernathy
DEPARTURE DATE: Monday, May 1, 2017TIME: 8:00am
RETURN TO SCHOOL: Monday, May 1, 2017TIME: 6:00pm
MODE OF TRANSPORTATION: Private Vehicle
COST OF FIELD TRIP: $9.00/child $4.00/Adult DUE TO TEACHER BY: Thursday, April 13, 2017
ARRANGEMENT FOR MEALS: Breakfast on your own. We will pack Baby Cougars lunch and snack. Parents will need to pack their lunches.
DETACH AND RETURN BOTTOM PORTION
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PARENTAL FIELD TRIP CONSENT FORM
Destination: Dan Nicholas Park Teacher: Mrs. Abernathy and Mrs. Lackey
Complete the Following:
Student Name: ______Parent Name:
Phone: Evening Daytime Cellular Pager
Address: Date of Student’s Birth:
Doctor’s Name: Phone #:
Name of Insurance Co. Policy #:
If parent cannot be located in the event of an emergency, contact:
Name: Address:
Phone: Evening Daytime Cellular Pager
Are you interested in being a chaperone? Yes No
I hereby certify that (student’s name) ______has permission to participate in the field trip according to the policies and provisions as stated above. In the event of an accident or medical emergency, I authorize the supervising teachers to seek medical assistance and I will assume responsibility for all expenses. I also agree to inform the supervising teacher if the child will need any medication administered to them or will need to self administer any medications while on the field trip (including all OTC and prescription meds.) I agree to follow the Alexander County Schools Medication Administration Policy in arranging for medication to be available for my child and understand that no medications may be administered without proper authorization from myself and my child's health care provider.
Parent Approval Signature Date _____/_____/_____
PLEASE RETURN THIS FORM (WITH PAYMENT) TO SCHOOL BY ______