ALLEN FREAR ELEMENTARY SCHOOL

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					         ALLEN FREAR ELEMENTARY SCHOOL
    PARENT/GUARDIAN APPROVAL SCHOOL TRIP FORM
                                                         Teacher:

Student Name: _______________________________ Date of Trip: 10/27/10

Departure from School: 8:00 a.m.          Arrival back to School: 6:00 p.m.

Mode of Transportation: School Bus

Cost: $15/student

Lunch/Snack: Brown bag lunch, drink, and snack. Please also
provide a snack & drink for the ride home. **NO glass bottled drinks
allowed.

Name & Phone Number of Child’s Dr.: __________________________________

Allergies: ______________________________________________________________

In Case of Emergency please call:

Home __________________ Work __________________ Cell __________________ Other _______

I hereby grant permission for the above named child to attend or take part
in the activity or field trip scheduled. I understand that no child is
obligated to go on the trip and the responsibility of the school cannot be
beyond the exercise of reasonable caution and supervision.

______________________________________________ ________________________
        Signature of parent/guardian                    Date
____________________________________________
                       Medication on Field Trip

If your child takes routine medication and needs to take this medication
on the field trip, please complete Columns 1 thru 4 on the form below:

My child can self-administer with assistance, the following medication on
the field trip. Medication must be in the original prescription container.

 Column 1          Column 2          Column 3         Column 4             Staff
 Medication          Dose:           Route: by         Time to be          Time
                   Amt. to be         mouth,             given             Taken
                     given            inhaled                            Signature




______________________________________________           ________________________
        Signature of parent/guardian                              Date


				
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