PATERSON PUBLIC SCHOOLS ___________________________________________________________________ School of Information Technology FIELD TRIP PERMISSION FORM My son/daughter (1) _________ has my permission to (print student name) participate in a field trip to (2) ____ on (3) ____ . (trip destination) (date) I understand that teacher, (4) will be in charge of the field trip. (teacher’s name) Method of Transportation: (5) ______ Approximate Time: (6) Departure: ______ Return: _____________ (7) Signature: (8) Date: (Parent/Legal Guardian) Note: Items # 1 – 6 are to be completed by the field trip sponsor/school staff member. Items # 7 – 12 are to be completed by the parent or legal guardian. SHORT TERM ILLNESS AND INFECTION Medication will not be given for any pre-existing short-term illness or infection on field trips. Children who are ill must remain at home and rest. Parents will be contacted in case of serious sickness or accident; however, an emergency situation that requires immediate medical assistance could occur during the excursion. Please provide two (2) phone numbers where a parent, guardian or authorized person may be reached to give consent to medical treatment. Emergency Contacts: (9) Name: Relationship: Telephone Number: (10) Name: Relationship: Telephone Number: In the event such persons cannot be reached, the following consent will be used: (11) I, the Parent/Guardian of give my permission in case of (print student name) emergency for a qualified medical doctor to administer any treatment and/or medication to my child. (12) Signature: Date: "Our Children, Our Future "
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