Student Field Trip / Excursion Permission Form

Basic Instructions
Field trips are an important experiential aspect of your son's education. It helps foster relationships, responsibility
and real life experiences. We would be thankful for your permission to take your son on a planned, educational
excursion. Please complete this form. It should then be returned to the school.

TO BE COMPLETED BY THE PARENTS AND RETURNED TO THE SCHOOL:

I give permission for my son/ward ________________________ to participate in a field trip from _______________
to __________________. (Student Name - Please Print) (Date)
(Date)
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Emergency Number(s) for Parent Guardian: _____________________ ________________________

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Alternative Contact Name: __________________________ Number: _____________________________

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My child has the following needs: Medical/Allergic/Dietary/Other Condition (Circle all that apply)
Please include information regarding the above needs below:
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____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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Swim/Water Activities Permission - If our students are involved in water activities, do you give
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permission for your son/ward to participate in these activities? Yes: _____ No: _____
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My son's/ward's swimming ability is (check one): Beginner _____ Intermediate _____ Advanced _____
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Authorization to treat minor injuries/infections: In the event I cannot be reached while my son/ward is on a field
trip and he needs minor treatment, I give permission to St. Mary's staff to secure appropriate treatment.
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Date: ____________________ Parent/Guardian Signature: ____________________________________________

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For High School Students Only: With permission from the parent/guardian and the supervising teacher/
coach, it is sometimes permissible for students to arrive at or leave the field trip destination on his own. Please
check below if you grant permission to your high school student to arrive at or leave the destination on his own.
Under this option, St. Mary's International School is not liable for any incidents that may occur.
My high school student will arrive at the destination on his own.
My high school student will leave the destination on his own.
My high school student will stay with school transport during the entire field trip.

Receipt:

Student Name: __________________ Grade: _________ Date: ____________________

Trip Name: ____________________________________ Amount: _________________