Field Trip Permission Form

Dear Parent or Guardian,

Your child is going on a field trip. Please read the information at the top of this form, then sign and return
the permission slip at the bottom of this form by December 09th, 2016.
Field Trip Information:
Date: December 12th 2016
Location: Stars and Stripes Museum/ Library; 17377 Stars and Stripes Way, Bloomfield, MO 63825
Purpose: For the students to see artifacts, and documents pertaining to what we have covered in class so
far this semester
Cost: 5-dollar donation, plus 10 dollars for lunch
Cash or check payable to: Our High School
Means of Transportation: We will be taking one of our school busses
Leave school: 8:30 a.m.

Arrive back at school: 3:00 p.m.

Save this part of the form for future reference.

Cut here-------------------------------------------------------------------------------------------------------------------- Cut here

Sign this part of the form and return it to your child's teacher.

_____________________________________________________ has permission to attend a field trip to

_________________________________________ on ____________________________________ from
_________________________________________ to ________________________________________.
Enclosed, please find cash/check in the amount of _____________________ to cover the cost of the trip.
I give my permission for ________________________________________ to receive emergency medical
treatment. In an emergency, please contact:
Name: _________________________________________ Phone: ______________________________

Parent/Guardian Signature: ___________________________________ Date: _____________________