Armstrong School District

ARMSTRONG SCHOOL DISTRICT

ARMSTRONG HIGH SCHOOL

FIELD TRIP PARENT PERMISSION

Students will not participate in the field trip without a permission slip previously signed and completed by their parent/guardian.

Date of Trip: OCTOBER 17 AND OCTOBER 23 Trip to: LENAPE ELM (10/17) AND WEST HILLS ELM (10/23)

Time Leaving: 8:15AM Place Leaving: ARMSTRONG HS

Time Returning: 10:45AM Place Returning: ARMSTRONG HS

Sponsor: AHS BAND Chaperone(s): MR. VENESKY

Method of Transportation: SCHOOL BUS Return Completed Form by: FRIDAY, OCTOBER 6TH

Parents or guardians of any student who is injured or becomes ill while on a school related trip which requires more than one hour of hospital attention, will have to pick up the child upon completion of the hospital stay. Parents or guardians should be aware of the above prior to granting permission for their child to take school related trips.

I hereby grant permission for ______to take this trip.

(Student’s full name)

______

Parent/Guardian Signature Date Phone Number where parent can be

reached on day of the trip.

EMERGENCY MEDICAL INFORMATION

Complete this section only if your child has specific emergency and or medical needs including medication administration.

Student Name:______Parent/Guardian Name:______

(Current Medication Administration Consent and Licensed Prescriber’s Medication Order form must be on file currently in the nurse's office.)

1). My child requires following medication in the event of an emergency (staff may administer emergency medication):

Medication :______(rescue asthma inhalers and epinephrine auto injectors)

Check appropriate box:

____My child may self-administer this emergency medication.

2). My child requires the administration of the following routine/daily medications:

______

____ My child will NOT receive his/her routine medication while on the field trip.

____ I will deliver the necessary routine/daily medication dose in an approved pharmaceutical container, with appropriate label, a written order from a licensed prescriber, and written parent consent. The routine/daily medication may be administered by licensed school health staff.

Date:______Signature of Parent/Guardian______

November 22, 2016