Field Trip Permission Form - Kenston Local Schools (Page 2 of 2) in pdf

Field Trip Permission Form - Kenston Local Schools Page 2

PARENT/GUARDIAN CONSENT TO PARTICIPATE

I hereby give consent for, ___________________________________________, to participate on this trip.

Print Student’s First and Last Name

In the event of an emergency, I can be reached at this phone number _____________________________.

If I am unable to be reached at that number, please call __________________________________ at this

number ________________________ .

Does your child require any special medications to be taken during the hours of this field trip?

Yes

If yes, please list________________________________________________

SIGNATURE OF PARENT OR GUARDIAN

X______________________________________

_____________________________

_______________

Signature of Parent or Guardian

Print Name

Date

PARENT/GUARDIAN MEDICAL CONSENT FORM

Please sign below according to your preference.

GRANT CONSENT

REFUSAL TO CONSENT

FOR MEDICAL TREATMENT

IF NONE OF THE ABOVE CAN BE REACHED, I AUTHORIZE

DO NOT

GIVE CONSENT FOR EMERGENCY MEDICAL

TREATMENT AT ANY REASONABLY ACCESSIBLE HOSPITAL.

TREATMENT OF MY CHILD. IN THE EVENT OF ILLNESS OR

SPECIAL MEDICAL INFORMATION / CONDITION:

INJURY REQUIRING EMERGENCY TREATMENT, I WISH

SCHOOL AUTHORITIES TO TAKE NO ACTION OR TO:

_____________________________________________________

___________________________________________________

_____________________________________________________

___________________________________________________

_____________________________________________________

SIGNATURE OF PARENT OR GUARDIAN

X______________________________________

Signature of Parent or Guardian

_______________________________________

Print Name

_______________

Date

Kenston Middle School

17425 Snyder Road ▪ Chagrin Falls, Ohio 44023 ▪ 440-543-8241

Field Trip Permission Form - Kenston Local Schools Page 2