Parent Permission Form

Horace Mann Middle School

School Sponsored Trip

 

 

I have read the description for the trip entitled:

 

                                          (date, times and name of the trip)

 

and give permission for my child,  ______________________________________

                                                                                       (student’s name)

to participate in the activities as outlined in the trip description.

 

My child and I understand and agree that while on this trip; my child is required to comply with ALL policies and regulations of the Horace Mann Middle School and the Franklin School District, particularly those pertaining to proper conduct and substance abuse.

 

_________________                       _____________________________________________

            Date                                      Parent/ Guardian signature – agreeing to terms of the trip

 

Emergency Contact Information

 

During the time of this trip, I may be reached at the following address and telephone number:

 

Address:  ___________________________________________________________

 

Telephone: __________________________________

 

Secondary telephone: _______________________________

 

Medical Information

 

My child is required to take the following medications:

                                                         (if none, please write none)

 

I hereby authorize my child to receive emergency medical treatment,

 

_________________                       ______________________________

               Date                                      Signature of Parent/guardian

 

Chaperones for the trip are:

 

__________________________________       _____________________________________

 

__________________________________       _____________________________________

 

__________________________________       _____________________________________

 

__________________________________       _____________________________________