PARENTAL PERMISSION AND LIABILITY RELEASE

I understand the arrangements for taking __Ski &Snowboard Club___on a field trip to _____Blue Mountain______on

(Group/Organization) (Destination)

6 Separate Dates . I hereby give permission for ______grade: ( 6 , 7, 8 )circle one

(Date) (Students Name)

to go on the field trip.

I further consent to allow emergency medical aid to be administered to my child by a qualified person if the need arises.

I hereby release the advisors, Mr. Fisher, Mrs. Angermeier, Mr. Boyer, Mr. Glenville, the Principals, Mrs. Vincent, Mr. Annoni, and Mr. Luckenbill and East Penn School District of all Liabilities.

Parent:______(Home)

______Parent:______(Cell)

(Date) (Parent/Guardian Signature)

Parent:______(Cell)
Alternate Emergency Contact Name/Relation______Number______

Any other health related issues (e.g. medications, allergies)______

Complete Both Sides and Return this portion and the check to Mr. Fisher in Room 507

Be sure to put student name, homeroom and birth date on the other side!

______

------Please tear here and keep the lower portion for Your Records------

Field Trip Information

Organization: Lower Macungie Middle School Time Departure Dismissed from Class at 2:05 p.m. Bus Leaves at 2:25 p.m.

Date(s) 1/7/16, 1/14/16 1/21/16, 1/28/16, 2/4/16, 2/9/16Approximate Return/Pick Up Time BY 9:30 p.m.

Cost to Student: Dependant on package selection Money Due By: October 19, 2015 on a First Come Basis

Type of Transportation: Coach Buses by Bieber TourwaysDestination:Blue Mountain Ski Area

*Make Checks Payable to: Lower Macungie Middle School

Meals Will NOT Be Provided:Must Pack Dinner: Students may pack a dinner or purchase a dinner at the lodge.

Additional Information: Students should change in locker rooms before loading onto bus. Bus leaves AT 2:25. Ski Boots and snowboard boots should be put on at the mountain.

Teacher/Advisor Names and Phone Numbers:

LMMS: 610-395-8593

In Case of an Emergency Only: Blue Mountain 610-826-6633 Ask for an LMMS Advisor to be paged

Mr. Rett Fisher:

Mrs. Diane Angermeier:

STUDENT NAME:HOMEROOM#:BIRTHDATE:

SKI and SNOWBOARD TRIP REGISTRATION FORM

(Checks made payable to: Lower Macungie Middle School)

The cost includes Coach Bus Transportation by Bieber Tourways and the package you chose for 6 Trips

Any Missed Trips can be made up after March 7, 2016. Transportation not included or refunded for missed trips.

Lift Ticket($220.00)$______

Lift & SKI Rental ($265.00)$______

Lift & SNOWBOARD Rental ($265.00)$______

Lift & SKI Lesson($265.00)$______

Lift & SNOWBOARD Lesson($265.00)$______

Full SKI Package (lift, rental and lesson)($305.00)$______

Full SNOWBOARD Package (lift, rental, lesson)($305.00)$______

Helmet (MANDATORY)Buy one or Rent one($30.00)$______

Total Amount Due: OCTOBER 19, 2015$______

(No full refunds after October 20, 2015 unless there is a replacement. Only a written doctor’s excuse will be considered for refunds after October 20, 2015. Bus fee is not refundable unless there is a replacement. Checks will not be cashed/deposited until October 20, 2015.

FIRST COME FIRST SERVE BASIS

COMPLETE BOTH SIDES & RETURN WITH CHECK