Ready Registration Form

ADVERTISEMENT

Extraordinary Field Trips
For Expanding Minds
Registration Form
th
for 7
Grade Team 7D & 7A
Student
lead teachers Mr. Basilio & Mr. John Gahan
Downingtown Middle School
Boston, MA
May 24-26, 2016
Name of School
Destination
Tour Dates
Male
NAME & ADDRESS
Female
Team
How old will you be
at the time of the trip?
First name
Last name
Birthdate
Street address
City
State
Zip Code
Parent’s e-mail address
Home phone number
Student's cell phone (for communication on trip)
Mother's cell phone
Father's cell phone
EMERGENCY CONTACT
(IF YOU ARE A CHAPERONE ON THE TRIP YOU CAN NOT BE AN EMERGENCY CONTACT)
Name of primary contact person
Relationship
Daytime phone
Evening phone
Cell Phone
Another person to contact if the primary contact person cannot be reached
Relationship
Daytime phone
Evening phone
Cell Phone
MEDICAL INFORMATION
List and describe all of your child’s known medical conditions:
List any medications your child takes regularly, or may need to take during the trip:
Insurance provider
Name of policy holder
Insurance provider’s phone
Policy/group number

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Education
Go
Page of 3