Calcasieu Parish School Boardcalcasieu Parish School Board

CALCASIEU PARISH SCHOOL BOARDCALCASIEU PARISH SCHOOL BOARD

PARENT-GUARDIAN PERMISSION FORM PARENT-GUARDIAN PERMISSION FORM

I hereby give permission for my childI hereby give permission for my child

______

(Student’s Name)(Student’s Name)

to participate in the field trip to___Burton Colisieum__4-H Acheivement Day_to participate in the field trip to__Burton Colisieum 4-H Acheivement Day _

(PLACE)(PLACE)

to be held on___March 22nd, 2016______to be held on____March 22nd 2016 ______

(DATE)(DATE)

I understand my child will be leaving school property and will beI understand my child will be leaving school property and will be

transported by______BUS______transported by______BUS______

(BUS, PRIVATE VEHICLE, ETC.)(BUS, PRIVATE VEHICLE, ETC.)

I understand that the School System has arranged for supervision. FurtherI understand that the School System has arranged for supervision. Further

that teachers and other supervisors cannot prevent all injuries and thatthat teachers and other supervisors cannot prevent all injuries and that

each student is expected to obey all the rules, regulations, and instructions.each student is expected to obey all the rules, regulations, and instructions.

In the event of any emergency, I can be reached by telephone at:In the event of any emergency, I can be reached by telephone at:

______

PHONE NUMBER (S)PHONE NUMBER (S)

If I cannot be reached, I agree to permit the supervisor of this activityIf I cannot be reached, I agree to permit the supervisor of this activity

to authorize emergency medical treatment for my child. Further, I to authorize emergency medical treatment for my child. Further, I

understand the School System does not carry medical insurance onunderstand the School System does not carry medical insurance on

the students.the students.

In the event of an emergency, or in case the trip is delayed for anyIn the event of an emergency, or in case the trip is delayed for any

reason, I want to make you aware of the following medical conditions,reason, I want to make you aware of the following medical conditions,

or other medical conditions, or other information concerning my child:or other medical conditions, or other information concerning my child:

______

______

______

______

I acknowledge that I am the natural and/or legal guardian and am acting inI acknowledge that I am the natural and/or legal guardian and am acting in

such capacity and further that I understand the contents of this document.such capacity and further that I understand the contents of this document.

PLEASE PRINT GUARDIAN NAME:______PLEASE PRINT GUARDIAN NAME:______

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PARENT/GUARDIAN SIGNATURE DATEPARENT/GUARDIAN SIGNATURE DATE

STUDENTS MUST TRAVEL ON THE BUS TO THE FIELD TRIP. SHOULD A PARENT WANT TO CHECK A STUDENT OUT AFTER THE TRIP, THIS MUST BE DONE AT SCHOOL PRIOR TO THE STUDENT LEAVING FOR THE FIELD TRIP. NO EXCEPTIONS; THIS IS SCHOOL POLICY AND IS LISTED IN THE SCHOOL HANDBOOK.