EDWARDS MIDDLE SCHOOL
Parental Approval Educational Field Trip
Dear Parents:
Your child is eligible for participation in an educational trip as described below. Please read the form carefully and provide the necessary information. No student will be permitted to participate on the trip unless he/she has first submitted a completed form, signed by the student and parent/guardian having sole legal custody of the child.
- Student’s Name ______Grade ______
LastFirstM.I.
Student’s Address ______
Street City Zip
Students will be traveling by______to ______
and will leave on Students will be returning to school at
Teacher in charge of trip Cost for the trip:.
EMERGENCY MEDICAL AUTHORIZATION
- Purpose – To enable parents to authorize emergency treatment for children who become ill or injured while under school authority, when parents cannot be reached.
In the event reasonable attempts to contact me at ______(phone number) or ______(other parent) at ______(phone number) have been unsuccessful, I hereby give my consent for: (1) the administration of any treatment deemed necessary by Dr. ______(preferred physician) or Dr. ______(preferred dentist), or in the event the designated preferred practitioner is not available, by another licensed physician or dentist: and (2) the transfer of the child to ______(preferred hospital) or any hospital reasonably accessible.
This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained before surgery is performed.
Facts concerning the child’s medical history including allergies, medications being taken, and any physical impairments to which a physician should be alerted: ______
______
______
Signature of Parent/Guardian ______Date ______
- It is understood and agreed that my child shall comply with all rules and regulations of the Board of Education, including suggestions, recommendations, rules and regulations of chaperones and staff members in all matters pertaining to the program or personal conduct.
I have read, understand, and accept the above-stated conditions. My child has permission to participate in this trip.
Signature of Parent/Guardian ______Date ______
Student Signature ______