Ph: 334-794-1436 Fax: 334-794-1439

FIELD TRIP PERMISSION FORM

Student’s Name ______________________________ Sponsor’s Name____________________________

Date_________________Activity_________________________________________________________

Departure Time_____________ Return Time_____________ Pick-Up Location___________________

TEACHER APPROVAL
SUBJECT TEACHER ASSIGNMENTS
APPROVAL
YES NO IN ADVANCE UPON RETURN
1.

2.

3.

4.

5.

6.

7.

PARENT APPROVAL
My son/daughter ___________________________________________________ has my permission

to go to______________________________________________________ on _______________.

I give the teacher/administrator in charge of my son/daughter permission to see that he/she gets whatever
medical treatment is necessary in the event of an emergency.

List medical exemptions (allergies, blood transfusions, handicapped conditions, medications, etc.)
Allergies:_____________________________________________________________________________
Handicapping Condition:________________________________________________________________
Blood Type (if known):___________________________________________________________________
My son/daughter is currently taking medicine prescribed by Dr.__________________________________
Name of Medication(s):__________________________________________________________________
Amount Taken:____________________________________ Time Taken:__________________________
Emergency Phone Numbers:_______________________________, ______________________________

Parent/Legal Guardian Signature:___________________________________ Date:__________________