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Adlai E. Stevenson High School Field Trip Permission Form 2004

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Adlai E. Stevenson High School Student Activities Field Trip Permission Form Name ID Date of Trip Type of Trip In School Date Departure Time Out of School Return Time Periods Missed Field Trip Coordinator Contact Phone Nature of Field Trip please describe Parents Your son/daughter will be participating in a Field Trip to City State Place to be visited and will be traveling by School Mini Bus Car driven by Adult Not recommended Charter Bus Airplane Train I give permission for my son/daughter to participate in this Field Trip. Parent/Guardian s Signature PARENTS - PLEASE FILL OUT THIS SECTION - IMPORTANT MEDICAL PERMISSION FOR TREATMENT DOES NOT APPLY TO IN-SCHOOL FIELD TRIPS Whenever injury or emergency illness occurs to the student listed below while the student is under the supervision of Stevenson High School personnel every attempt will be made to notify the parent or guardian immediately. However if the parent or guardian is not available and it is felt that emergency treatment is indicated the signatures below by the grant authority to administer emergency treatment of any and all medical conditions. Student s Name Parent Phone Number Please supply the following information if applicable Medical conditions Medications Name and Phone Number of person to contact if parent cannot be reached COMPLETE OTHER SIDE IF YOU ARE MISSING ANY OF YOUR CLASSES PLEASE RETURN TO SPONSOR PRIOR TO FIELD TRIP - DUE DATE Please have your teachers sign This student will be missing the following classes. Your signature indicates that this student talked to you about the work they are missing* If you feel this student should not miss your class arrangements can be made for him/her to attend. Class Comments Teacher Signature Not Applicable for this Field Trip Request to Transport Students by Personal Vehicle Guidelines Please be advised that when faculty/staff are transporting students in their personal vehicles their individual automobile insurance policy is the primary source of insurance coverage. Parent permission slip must be completed and on file with the Director before such a trip commences. Faculty/staff are discouraged from transporting students in their personal vehicles. Every effort should be made to transport students in District vehicles or by the designated school bus company. Name of Group Destination Make and Year of Vehicle License Faculty/Staff Signature Director s Signature Rev* 2/04-ksz. However if the parent or guardian is not available and it is felt that emergency treatment is indicated the signatures below by the grant authority to administer emergency treatment of any and all medical conditions. Student s Name Parent Phone Number Please supply the following information if applicable Medical conditions Medications Name and Phone Number of person to contact if parent cannot be reached COMPLETE OTHER SIDE IF YOU ARE MISSING ANY OF YOUR CLASSES PLEASE RETURN TO SPONSOR PRIOR TO FIELD TRIP - DUE DATE Please have your teachers sign This student will be missing the following classes. .

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