Fm-2431 Form - Parent Permission Form - Field Trip - Miami-Dade County Public Schools

Division of Athletics, Activities and Accreditation

MIAMI-DADE COUNTY PUBLIC SCHOOLS

PARENT PERMISSION FORM -- FIELD TRIP

Field trips are not mandatory. They are designed to enhance curriculum, to encourage student participation in extra-curricular activities, and

to serve as community service projects.

SECTION I. IDENTIFYING INFORMATION

SCHOOL _________________________________________________________________DATE________________________________

STUDENT'S NAME _________________________________________________________I.D. NO. ___________GRADE/HR_________

SECTION II. NOTIFICATION TO PARENT

__________________________________ is planning a field trip for ___________________________ to __________________________

School Group Sponsor Name

Name of School Group

Destination

The purpose of the trip is __________________________________________________________________________________________

TRANSPORTATION: Private Vehicle ________ Bus ________ Airline ______________________Other____________________________

Name of Carrier

Please Specify

This trip will be chaperoned by ____________________________________________

Cost to each student $ ____________________

(Total Number of Chaperones)

I understand that if I am unable to pay for the cost of this trip, and I want my child to participate, where appropriate, my child will be given an

opportunity to raise funds through authorized fund-raising activities, or be given assistance in identifying another funding source. (This provision does

not apply to activities not directly related to classroom instruction, e.g., Grad Nite, football games, banquets.)

DATES OF TRIP:

FROM _____________________________ TO ___________________________

(Include departure/return time)

--The above time schedule and/or personnel may be changed due to unforeseen circumstances. --

PLEASE KEEP THE TOP PORTION FOR YOUR INFORMATION.

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RETURN THE BOTTOM PORTION TO THE TEACHER.

SECTION III. PARENT/GUARDIAN'S WRITTEN PERMISSION TO PARTICIPATE IN ACTIVITY

I hereby give permission for my child ___________________________________________ Student I.D. No. _______________________

(Child's Name)

to participate in the field trip to______________________________________________________________________________________

(Destination)

DATES OF TRIP:

FROM _____________________________ TO ___________________________

(Include departure/return time)

I have completed the EMERGENCY CONTACT INFORMATION in Section IV (see below).

SIGNATURE OF PARENT/GUARDIAN _____________________________________________ DATE____________________________

SECTION IV. EMERGENCY CONTACT INFORMATION

1. Name of parent/guardian ____________________________________________________

2. Parent/Guardian Phone No(s). Home______________________________

Business ___________________________

Cell________________________________

3. In case parent/guardian cannot be reached, please contact:_____________________________ Relationship __________________Telephone No. _________________

4. Please list any insurance policy covering your child ___________________________________________________ Policy No. __________________________________

5. Physician's Name ______________________________________________________________Telephone No. ______________________________________________

5. Only if applicable, complete the following:

a. My child has the following medical problem:_____________________________________________________

FM-4573E Rev. (09-09)

b. My child takes the following medications regularly:________________________________________________

(Proper Medical form #2702 is on file at the school)

c. My child has the following allergies: ____________________________________________________________

I AUTHORIZE MEDICAL TREATMENT FOR MY CHILD IN CASE OF ACCIDENT OR ILLNESS WHILE ON THE TRIP.

Clear Form

PARENT/GUARDIAN SIGNATURE _______________________________________________________________DATE________________________________________

FM-2431 Rev. (08-15)