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

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 "

To top