Field Trip Permission Form

Dear Parent(s) or Guardian(s),

The fourth graders of Lewis Elementary School will be taking a very exciting field trip! Please
read the following information about the trip and fill out all information needed. Then, sign
and return the bottom portion of this form and payment to your childs teacher NO LATER
than Tuesday, October 21, 2014. Children will not be able to participate in this event without
a signed permission form. Feel free to contact your childs teacher at (334)555-4559 if you
have any questions or concerns. Thank you!
Destination: Childrens Hands-On Museum in Tuscaloosa, Alabama
Cost: $ 7.00
Date: Tuesday, November 18, 2014 Departure Time: 9:30am Return Time: 2:10pm
Purpose / Learning Objective: Students will enjoy experiencing the daily life of the four
Native American tribes that we will be studying in the coming weeks through an interactive
village at the museum.
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_______ Yes, my child has permission to attend the field trip to the Childrens Hands-On Museum
_______ No, my child will not be able to attend the field trip to the Childrens Hands-On Museum
_______ My child will pack and bring their own lunch from home.
_______ My child will need a bagged lunch from the Lewis Elementary School Cafeteria.
I understand that my child will attend this trip as stated above and will travel by school bus. Teachers will exercise all caution possible, but
in the case of any unforeseen accident, I give the faculty and staff of Lewis Elementary School permission to care for my child by following
the Narnia County School District policies. I understand that my child will be expected to follow all rules, just as they are in the classroom.
Student Name: _________________________________________________________________________
Parent Signature: ________________________________________________________________________
In case of emergency, please contact:___________________________________________________
Allergies or Special Notes: _______________________________________________________________
(Please PRINT name, relationship and phone number for emergency information. Please be sure that information is current.)
Two parent You will also need to fill out a district Volunteer Form, if you have not already done so. Chaperones will be
chosen on a first come first serve basis. If you are interested, please fill out the following information.
Contact Name: _____________________________________________ Phone Number: _____________________________

Dear Parents and Guardians,

I am so excited to share with you a field trip opportunity that your students will be able to attend next
month! As you know, in a few weeks we will be starting a unit on the Alabama Native Americans and the
Childrens Hands-On Museum in Tuscaloosa has invited us to come and visit their Southeastern Celebration
exhibit. During this trip students will have the opportunity to Discover the original Southeastern peoples from
the Choctaw, Cherokee, Creek, and Chickasaw tribes. Journey back in time in our Choctaw Village to hear the
heartbeat of Mother Earth and the music of the time. Play authentic games and examine Native American
artifacts from Moundville. Discuss human migration, Native American language, and traditional family roles of
long ago.
I will be sending home permission forms next week, so be on the lookout. I will need your students
signed form and money turned in as soon as possible to ensure that they will be able to attend this trip. Just a
few housekeeping things; you may either choose to pack your childs lunch or purchase a sack lunch from the
cafeteria as we will be eating lunch outside on the Government Plaza before returning to school. Students are
not permitted to bring electronics on this trip, you will be receiving a form closer to the date detailing contact
information should you need to get a hold of your child while we are away. Students will need to wear their
class t-shirt for this event.

Ms. Atkins
(334) 555 4559
latkins@lewiselementary.com









Classroom Expectations and Preparation


The teacher will remind the students of the following rules:
o Be Resourceful
o Be Respectful
o Be Responsible
o Be Safe



















Student Management Plan

Student attire: Students will wear class t-shirts with choice of bottoms and closed toe shoes.

Groups: There will be three groups of six students. Each parent chaperone and the teacher will be group
leaders. Six students to each chaperone.

Bus Rules: NO FOOD OR DRINK on the bus. Students will sit two to a seat in seats assigned by the teacher.

Special Rules: Students must stay in their assigned groups. Students may not travel anywhere without their
adult chaperone. Students may not bring electronics on the trip.











Field Trip: Emergency Plans

In the event of an emergency, including but not limited to:
-Lost or missing student
-Medical emergency (including serious injury)
-Natural disasters (including inclement weather)
-Physically dangerous acts, illegal acts, or extreme disciplinary problems

Actions to be taken:
-summon professional medical attention
-report accident immediately to teacher
-students should always be attended by an adult
-follow the safety protocol of the Museum










Communication


Parent chaperones and teachers must have their cellphones on them at all times. All parents will be provided
with contact sheet with numbers including the schools and teachers, and the address of the museum. Bus
drivers will be provided with the contact information of the school, teacher, and parent chaperones for
emergencies.




















Assessment

Pre-assessment: Students will complete a 3-2-1 Chart when they arrive at school. 3 things they want to learn,
2 things they want to see, and 1 thing they want to do. To be turned in in place of morning work.

Post-assessment: Students will complete a PQP card upon returning to the classroom. Students will write one
praise one question and one polish in relation to their experience at the museum.













Name:

Field Trip 3-2-1

3 things I want to learn:




2 things I want to see:




1 thing I want to do:





Name:

Field Trip PQP

Praise:




Question:




Polish:







Follow-Up


Students will compose a thank you letter to the Childrens Hands-On Museum, thanking them for their
experience and describing at least three things that they learned while they were at the exhibit. Students will
also draw a picture of their favorite thing that they did on the field trip. The letters will be collected and mailed
to the CHOM as a thank you for hosting our class.