New York Historical Society: FIELD TRIP PERMISSION FORM

Students are going on a field trip to the New York Historical Society to gain a hands
on learning experience related to content they’ve been studying in social studies
class! On the trip they will be divided into three groups to learn more about
slavery in New York, the British in New York, and the American Revolution in New
York. Field trips are an extension of the classroom and all field trip rules must be
followed 

TRIP INFORMATION
Location & Address: New York Historical Society, 170 Central Park West

Date: Wednesday, February 7th, 2018

Transportation: Subway

Time we will leave school: 10:15 am (the programs begin at 11:30 am and end at 1:15 pm)

Time we will return to school: 2:30 pm

 Please SIGN and RETURN this permission slip in your scholar’s homework folder
no later than one week before trip (1/28/18). If this slip is not returned by the
due date, your scholar will not be able to attend the trip.
I give my child, __________________________________________________ permission to attend the field trip.

Yes  No  Medical Release: I give permission to AFENYES’s staff to administer immediate first aid and authorize a
first responder and/or physician at a local hospital to secure proper treatment for myself or my child in the
case of a medical emergency.

Yes  No  Playground Release: I give permission for my child to use indoor or outdoor playground equipment while
attending this field trip. I understand that students will be under the supervision of AFENYES teachers or
staff while using playground equipment.

Yes  No  Chaperone: I want to chaperone the field trip. Each class is only able to bring 3 chaperones on the
field trip!

If YES: Your name: ___________________________ Phone Number: _____________________

Dietary Restrictions or Special Needs: ___________________________________________________________

Please list two day-of emergency contacts below:

Name Relationship Phone Number
1.
2.

My child and I are familiar with the AF East New York culture and behavior expectations. I understand that my
scholar must be in full uniform and abide by all school rules and policies while attending this school function.

I hereby release Achievement First East New York Charter School, its staff members, and its officers from any
liability for any injuries, damages, or losses associated with this field trip, medical response (if checked above),
and playground use (if checked above).

Parent/Guardian Signature __________________________________________ Date ____________________