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Field_Trip_Permission_Form

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									                                 TROUT LAKE SCHOOL DISTRICT #400
                                            P.O. Box 488
                                        Trout Lake WA 98650


                                      Field Trip Permission Form
                                         To be completed by both parent and student

I hereby grant the Trout Lake School District permission to take my son/daughter, (name)
____________________on field trips during the 2011-2012 school year. Itineraries and rules
for each field trip will be sent home with the student prior to the trip.

Allergies or other health problems (describe)_______________________________________

__________________________________________________________________________

Medication_________________________________________________________________

Doctor’s name __________________________________phone number: ________________

Parent or Guardian daytime phone number_________________________

Emergency contact person__________________________phone number________________

COMMENTS________________________________________________________________

___________________________________________________________________________

INSURANCE CO. NAME___________________________POLICY NO._________________

========================================================================


In the event of illness or accident, I authorize the school-designated personnel responsible for this trip to approve
medical emergency care. Further, I agree to indemnify and hold harmless the Trout Lake School District #400 for
any and all medical expenses not related to their sole negligence. In addition, I agree to take full responsibility for
my child’s conduct.

_____________________________________________                                         _____________________
     Signature of Parent or Guardian                                                       Date

I pledge that my conduct will at all times reflect credit upon my parents, my school, and myself. I understand the
school rules of conduct apply while on this trip.

____________________________________________                                          _____________________
    Signature of Student                                                                   Date




Student’s grade____

								
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