For Student Field Trip

Parent/Guardian Information

For Student Field Trip

Dear Parent or Guardian:

Your child is invited to participate in the field trip that is described below. After carefully reviewing the information provided, please sign the attached permission form for your child to participate. If you do give permission, you must provide us with answers to the questions on the Permission Form. After answering the questions, sign and date the form indicating your permission and your agreement with the information provided, and return it to the contact teacher. If you would like to discuss the field trip or the form with us, or if you require additional information before making a decision, please call the contact person listed below.

School: Pathways Academy of Technology & Design
Contact Teacher: Jessica Fitzgerald

Date of Departure From School: Pathways 8/11/2017 Time: 8:00 AM

Date of Return To School: Pathways 8/11/2017 Time: 1:30 PM

Destination: 20 Leibert Road, Hartford, CT 06120

Transportation: Specialty Transportation

Itinerary

All trips and activities may involve some risk of injury to children, and we cannot guarantee that no injuries will occur. This trip will involve the following special activities: [Describe or “None”]

None______

______

We expect students to behave appropriately during the trip and comply with all school rules. We reserve the right to exclude your child from the trip in the event of a serious disciplinary offense. We may require you make arrangements for his or her transportation home if your child disrupts the trip.

The cost of the trip will be $_0_ per student. IT IS SUGGESTED THAT STUDENTS BRING MONEY FOR SNACKS

This amount must be paid by: ___----______

No refunds will be made after _____----______under any circumstances.

------

Contact Teacher on Trip: Jessica Fitzgerald______Tel. #: 860-695-9494

Administrator Contact at School During Trip: David Goldblum Tel. #: 860-695-9450

7/12

Parent/Guardian Student Travel Permission Form

Will your child require any special care in connection with this trip? Include a complete description of your child’s allergies, medication requirements and medical, physical or mental conditions that may be important in caring for or supervising your child.

None Yes My child requires special care because of the following:

______

Do any of the special conditions connected with the field trip impact your child?

No Yes The following special conditions of the trip are of particular concern because my

child (example: cannot swim, is allergic to poison oak, is afraid of heights, etc)

______

We will contact you immediately in the event of the need for emergency medical treatment for your child. However, in the event of an emergency before we can contact you, do you authorize us to provide emergency medical care?

Yes No

Do you understand, and agree, that all trips and activities involve some risk of injury to children and we cannot guarantee that no injuries will occur?

Yes No

Do you understand, and agree, that your child may be excluded from the field trip in the event of a serious disciplinary violation?

Yes No

Who may we contact during the period of the trip if we need to notify you of a problem, change of plans or emergency? Please provide more than one name.

Name: ______Telephone # ______Relationship______

------

I give permission for my child [Name] ______to participate in the field trip and that the information provided above is true and complete.

Parent/Guardian Name: [Print]______Date: ______

Parent/Guardian Signature: ______

7/12

Dear Parents:

We are pleased that your student will be participating in an educational travel experience with our school.

As part of the preparation process, it is required that you sign this waiver form in order for your student to participate.

A trip may be cancelled due to unforeseen world events or medical concerns in a particular area of the world. In some cases when a trip is cancelled, the travel agency will not refund the deposit or the cost of the trip. While this is very unfortunate, the Hartford Public Schools cannot provide any refunds to help with the loss of funds.

------

PARENT WAIVER

I understand that the deposit, or entire cost of the trip, may be non-refundable in the event that the trip is cancelled due to unforeseen world events or medical conditions.

I understand that the decision to cancel a trip is the sole prerogative of the Hartford Public School administration and will be based on student safety.

Name of Parent/Guardian: ______

Signature: ______

Name of Student: ______Date: ______

School: ______Teacher: ______

RETURN SIGNED FORM TO THE TEACHER SPONSORING THE TRIP.

7/12