TIFT COUNTY HIGH SCHOOL by Sk6813Vm

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									                                     TIFT COUNTY HIGH SCHOOL
                                   FIELD TRIP PARENTAL CONSENT

THIS FORM MUST BE COMPLETED, SIGNED, AND RETURNED TO THE TRIP SPONSOR BY

                                                   . NO STUDENT IS ALLOWED TO PARTICIPATE
                   (Date)
IN THE FIELD TRIP WITHOUT THIS FORM COMPLETED AND SIGNED BY PARENT/GUARIDAN.

TO THE PARENT/GUARDIAN OF________                                                                                                 _
                                                                             (Student Name)
A field trip is scheduled as follows:             Group/Class/Club

Day(s)                 Date(s)                              Trip Sponsor/Teacher

Destination/Location

City                          State               Phone Number

Departure Time From School_                                           Return Time To School

Cost Per Student $                      Additional funds/materials student needs to bring


Insurance Company__________________________________Policy/Group #___________________________

Family Doctor______________________________________City_______________________State_________

I/we do hereby give our permission for our son/daughter named above to accompany the above group and
participate in the activities involved.

Parent/Guardian Signature__________________________________________________Date_______________

******************************************************************************************
                            STUDENT MEDICAL INFORMATION

Does student take prescribe medicine regularly/routinely for chronic medical condition, ie. Asthma, diabetes, hyperactivity, etc.? YES /
NO If yes, List medicine________________________________

Does School have permission to administer above medicine? YES / NO

Medical considerations. Please use the reverse of this form to describe any special medical problems/considerations of this student.

I/we authorize emergency medical treatment by any licensed emergency or medical person or facility and permit school personnel to seek
medical treatment should parent/guardian not be available. The undersigned also hereby releases and agrees to hold harmless and
indemnify the Tift County Board of Education and any employee of the board from any liability whatsoever occasioned by the
administration or nonadministration of any medical treatment during school hours at school-related events/functions in accordance with
the above information and instructions.

Parent Name__________________________________________Telephone #____________________

Parent/Guardian Signature_____________________________________Date____________________

								
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