Field Trip Permission Form - Three Rivers Charter School
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1T h r e e R i v e r s C h a r t e r S c h o o l
1211
D
M
D
EL
AR
RIVE
F
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CA
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ORT
RAGG
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TRCSCHOOL
ORG
P
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(707)
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Field Trip Permission Form
I hereby give my permission for _______________________ (student name)
to attend a school field trip as follows:
Description of Activity: _________________________________________
Date(s):
Location:
Departure
time:
Supervising
Return
Staff
Time:
Member:
In case of accident or injury I give permission for the supervising staff
member to authorize medical treatment by a licensed physician. I understand
that I am responsible for any expense incurred as a result of obtaining the
necessary medical care.
[ ] I cannot drive.
[ ] I will drive my student only.
[ ] I will drive my student and _____ others.
Phone(s):
Home:
Emergency:
Emergency Contact
and Number:
Does your child need
to take medication
during the field trip?
Please explain:
My child has the
following health
condition(s):
Parent Signature
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