FIELD TRIP INFORMATION/PERMISSION FORM

PARENTS/GUARDIANS:
The students at the Independent Learning Center have the opportunity to participate in an
educational study trip to:
Antlers Park and Subway Restaurants

Date: April 29, 2015

Departure Time: 8:00 AM Return Time: 2 PM
Cost to Student: Cost of Lunch and Bus Fairapproximately $10
Transportation for this activity will be provided by:
Public Transit
Students will need to bring a sack lunch: No *
*Vehicle will be checked by administrator/designee using the Auto Safety Checklist.
Detach the form below and return it to school no later than:

--------------------------------------------------Detach & Return---------------------------------------------PERMISSION SLIP

NAME OF STUDENT

Grade

In the event of an emergency and the Center is unable to reach you, do you authorize school
officials to obtain the necessary medical aid including Medivac service, if needed at your expense?
Yes

No

Permission is given for my child to take this field trip to:

Signature of Parent/Guardian:

Date

Telephone:_______________________ Emergency Telephone:____________________