Parent Permission For School Trip Form - School District 24j printable pdf download

Stk #450482

INS-F015

Rev. 01/11

School District 24J

Salem-Keizer Public Schools

Name of Student __________________________________________________

Student Number ___________________________________________________ School _____________________________

PARENT PERMISSION FOR SCHOOL TRIP

In order for my child, a minor, named above to take part in and receive the advantages of a program planned and

sponsored by Salem-Keizer School District 24J, Marion County, Oregon, I am hereby giving permission for him/her to make

any or all of the trips included in the planned program of the school.

Is your child on a health management plan?

Yes

Transportation may be provided at the discretion of the School District in such form as is approved by the Superintendent.

I authorize 24J and its employees to secure the services of a physician or hospital, and to incur expenses for necessary

services in the event of accident or illness, and I will provide payment for these. Every reasonable effort will be made to

reach the parent(s) as soon as possible.

Signed ___________________________________________________________ Date _______________________________

Parent/Guardian

Address _______________________________________________________________________________________________