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					SOUTH GWINNETT HIGH SCHOOL FIELD TRIP/SCHOOL ACTIVITY PERMISSION FORM
This will give my son/daughter, participate in: _______________________________________________________________________ permission to (Student Name) (Student Number) Place:___Oglethorpe University, Atlanta, GA__ Time of Departure: ____9____________AM Classes Missed: 1 2 3 4 5 6 7 None

Activity:_Julius Caesar play __________________ Date:_Wed. Oct. 28____

Teacher in charge:_D. Martin/G. Bonaby/K.Gordon/D. Muse__

If activity is to occur during school day, please complete the items below. Teachers: Please sign below and indicate current academic status (pass/fail) of student participating in the above mentioned activity. Students with a documented academic deficiency may be denied trip participation. (1)__________P F (2)__________P F (3)__________P F (4)__________P F (5)__________P F (6)__________P F (7)__________P F

A contribution of $__20_____is requested to cover costs associated with the activity. No student will be denied an opportunity to participate because of failure to contribute; however, if enough funds are not secured, the activity may be canceled. I give permission for my son/daughter to: (Please initial choice) ______ 1. Ride the bus ______ 2. Ride with an adult chaperone ______ 3. Ride with another student ______ 4. Drive own car

Describe any special allergies or medical problems of which we should be aware: _________________________________________________________________________________________ _________________________________________________________________________________________ Describe any medication your child will be taking, including medicine name and possible side effects: _________________________________________________________________________________________ _________________________________________________________________________________________ I agree to assume responsibility for any unforeseen accident that might occur during travel or participation in this activity. I also authorize any emergency medical treatment that may be necessary. I further recognize that students on school trips must adhere to the same code of behavior as if they were on the school campus and are to follow instructions of teachers, sponsors, or chaperones. I am aware of my son/daughter’s current academic status as indicated above. _____________________________________ Parent’s Name (Please Print) _____________________________________ Home Address _____________________________________ Person to Contact in Emergency ________________________________________ Parent’s Signature ________________ Home Phone No. __________________ Business Phone No.

________________________________________ Emergency Phone Number

__________________________________________________________________________________________________ Hospitalization Carrier & Policy Number NOTE: Form must be submitted to the Assistant Principal for Attendance at least five (5) days prior to trip. Original: Teacher/Sponsor Copy: Assistant Principal


				
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