Field Trip Or Excursion Parental Information Page 2
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2MEDICAL RELEASE
Authorization is hereby granted to the director of the group to secure necessary medical
attention and/or hospitalization of __________________________________________.
In the event of a medical emergency, the parent or guardian shall be contacted prior to such
action, and if this is not possible will be notified as soon as possible.
Person to Call in Case of Injury____________________________________________________
Relationship____________________________________ Phone_________________________
Please indicate any special health problems which should be noted and adequate precautions
taken:
(list such items as unusual severe reaction to bee stings, other severe allergies,
hemophilia, diabetes, heart disease, etc.)
SIGNATURES
I agree with the Excursion Code of Conduct and the attached itinerary and give permission for
my son/daughter to participate. I further understand that if my son/daughter violate any rules
set forth, I may be responsible for costs associated with sending him/her home early. (Parents
will be notified if student behavior warrants being sent home early.)
Student:__________________________________ Date _______________________
Parent/Guardian: _________________________ Date _______________________
Dear Colleague:
This field trip is planned for the educational benefit of this student. Please discuss the effect of
this absence with the student and arrange for assignment(s). Initial below to indicate a
satisfactory understanding has been reached.
Thank you for your cooperation.
Period 0
Period 4
Period 1
Period 5
Period 2
Period 6
Period 3
DF-48-13
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