Parent/guardian Authorization For International Field Trip Form printable pdf download

Parent/guardian Authorization For International Field Trip Form

Parent/Guardian Authorization for International Field

Trip

Directions:

SPS Staff:

1) Use one form per trip.

2) Complete the School Portion of form on page 1.

3) Duplicate one form per student.

4) Send a copy home for parent and student signatures.

5) During the field trip, the signed, original form must be carried by the lead chaperone and a

photocopy must be left on file in the school office.

Student:

1) Complete the “Student Agreement “on page 1.

Parent / legal guardian, if student is under 18 years of age,

or student, if at least 18 years old:

1) Complete the “Authorization and Acknowledgement of Risks” and “Medical Authorization” on page 2.

2) Complete the “ Medical Information Form” and “Medication Administration Form” on pages 3-5.

School Name:

Student Name:

Date(s) of Trip:

Destination:

Purpose(s):

List of Activities:

Supervision: (Check One.)

□ Students will be directly supervised by adult chaperones on this trip at all times.

□ Students will be directly supervised by adult chaperones on this trip with the following exceptions:

Mode of Transportation: (Check all that apply.)

□ school bus □ charter bus □ scheduled airline □ boat/ferry □ train □ Other ______________________

Students will leave from: ______________________________at ____________________.

(where)

(time)

Students will return to: ________________________________at about _______________.

(where)

(time)

Chaperone(s) in Charge:

___________________________________________________________________

Chaperone/Student Ratio: _____________________ (maximum ratio 10:1)

STUDENT AGREEMENT

While participating in this field trip, I understand I will be a representative of SPS and my community. I

understand that appropriate standards must be observed, and I will accept responsibility for

maintaining good conduct and abide by school based rules and the Basic Rules of Seattle Public

Schools – Code of Prohibited Conduct.

_________________________________________

_______________________

Student Signature

Date

Parent/guardian Authorization For International Field Trip Form

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