CENTENNIAL SCHOOL DISTRICT
STUDENT TRIP INFORMATION
Date: Monday, Jan.12th, 2015
Dear Parent:
This notice is to inform you that your child’s class/organization is scheduled for an educational trip. The details of the trip are as follows:
Destination: / Log College Middle School- Set-BuildingDate: / Saturday, Jan. 17th and Saturday, Jan. 24th
Departure Time: / N/A
Return Time: / Parents should pick up students by 4pm.
Group: / HSM Cast & Crew and Parents
Cost: / N/A
Please indicate receipt of this letter and your being informed that your son/daughter will have the opportunity to participate in this trip by signing the section below and returning it to school by…
Date: / Fri. Jan. 17th / Teacher: / Ms. Lenox/Mrs. Catalano/Mrs. SchefeltSpecial Notes:
1. The Centennial School District is not responsible for services not delivered by non-school
contractors/firms.
2. The Centennial School District assumes no liability for activities conducted as a part of a school trip.
Student’s Name:Trip: / Log College Middle School- Set-Building
Date: / Saturday, Jan. 17th and Saturday, Jan. 24th 12pm-4pm
This will acknowledge receipt of information regarding the above mentioned educational field trip and permission for my child to participate.
Parent Signature: / Date:
CENTENNIAL SCHOOL DISTRICT
FIELD TRIP PERMISSION FORMPARENT/GUARDIAN HOLDS HARMLESS AND ACKNOWLEDGEMENT OF RISK AGREEMENT
Dear Parent or Guardian:
In anticipation of your student’s upcoming field trip, we provide the following information. This agreement is entered into with the full understanding that the field trip may involve activities, which, by their very nature, may be hazardous, and under circumstances which render individual supervision difficult. Fully acknowledging this, your signature gives permission for son/daughter to attend the field trip.
Sponsor/Teacher Name: Leno/Catalano/Schenfelt School: Log College Middle School
Name of Student Grade/Homeroom D.O.B. ______
Address ______City______State______Zip ______
In compliance with District policy, no student is permitted to carry any form of medication. Arrangements for transport of medication essential to your student'’ health should be made with the school nurse. If your student will need any medication during the trip, you are encouraged to accompany your student.
Parent or guardian of student requiring daily medication must check one of the following:
1. I understand that my student will omit his/her daily scheduled medication on the day of the trip.
2. My student may take his/her regularly scheduled medication upon returning to school.
3. If space allows, I will accompany my student on the trip, at personal expense and I will administer his/her medication.
4. The sponsor, teacher or school nurse may administer my student’s required medication during the trip.
If you check #1 or #2 please provide doctor’s note of confirmation to the school nurse five days prior to the scheduled field trip.
The following information must be supplied for all students attending this field trip:
A PARENT OR GUARDIAN CAN BE REACHED AT THE FOLLOWING TELEPHONE NUMBERS ON THE DAY OF THE ACTIVITY:
Mother or Guardian ______Home______Work______
Father or Guardian ______Home______Work______
PERSON TO CALL IF A PARENT OR GUARDIAN CANNOT BE REACHED:
Contact #1 Name______Phone______
Contact #1 Name______Phone______
PHYSICIAN Name:______Phone______
ANY SERIOUS ALLERGIES, MEDICAL CONCERNS OR DIETARY ISSUES:______
______
______
INSURANCE INFORMATION: CARRIER______POLICY NUMBER______
In case of illness or emergency, I authorize the officials of Centennial School District to contact directly the persons named on this form. In the event parents, physician, or other persons named on this form cannot be contacted; the school officials are authorized to take whatever action is deemed necessary for the health and safety of my student. I also give my permission that my student may be taken to the hospital and treated in case of emergency.