Madison Junior School

160 Main Street / Nicole Sherrin, Principal
Madison, New Jersey 07940 / David Coster, Assistant Principal
Phone: 973-593-3149 / Fax: 973-966-1908

Please complete this form, as well as the electronic Health and Contact Information survey which will accompany your child on the field trip. No student will be allowed to participate without both forms being filled out and signed by the parent or guardian. If you require a paper copy of the Health and Contact Information survey, please let us know and we will provide one for you.

Permission is granted for ______to take part in the trip(s) marked

(Student’s Name)

below. In both cases, students will be driven by bus to the destination.

  • Please write TWO separate checks payable to Madison Junior School, one for each trip. Be sure to include your child’s name in the memo section of each check.
  • Please return this signed permission slip with payments to Mr. Newbery NO LATER THAN Thursday, April 23.
  • Please follow the QR code below or type the web address into your computer’s web browser to complete the online Contact & Health Information survey. It may be needed in case of an emergency. This information does not modify the information on the emergency card.

Scan this QR code to be taken directly to the survey on Google Forms

If you would like your child to attend one or both trips, please indicate that in below by checking either yes or no.

Madison Junior School

160 Main Street / Nicole Sherrin, Principal
Madison, New Jersey 07940 / David Coster, Assistant Principal
Phone: 973-593-3149 / Fax: 973-966-1908

Fairview Lake trip May 11

___Yes my child will be attending

Metropolitan Museum of Art trip June 8

___ Yes my child will be attending

Madison Junior School

160 Main Street / Nicole Sherrin, Principal
Madison, New Jersey 07940 / David Coster, Assistant Principal
Phone: 973-593-3149 / Fax: 973-966-1908

___ No my child will not be attending

Where: Fairview Lake YMCA

1035 Fairview Lake Road

Newton, NJ07860

When: May 11

Cost: $60 per student

Departure time:7:30 am

Return time:4:30 pm

___ No my child will not be attending

Where: The Metropolitan Museum of Art

1000 5th Ave.

New York, NY 10028

When: June 8

Cost:$14

Departure time: 9:15 am

Return time:4:30 pm

Madison Junior School

160 Main Street / Nicole Sherrin, Principal
Madison, New Jersey 07940 / David Coster, Assistant Principal
Phone: 973-593-3149 / Fax: 973-966-1908

Parent/Guardian Name (Please Print): ______

Parent/Guardian Signature: ______Date: ______

To any doctor or hospital: The above signature constitutes authorization to perform any necessary treatment for my child during this field trip/

I am aware that even when every precaution is taken, unavoidable accidents may happen. I will not hold the teacher or the school responsible should such an accident occur.

Field Trip Guidelines

  • Dress Code Applies
  • The MJS Code of Conduct Applies
  • If the teacher allows electronic devices-The school is not responsible for lost or stolen electronic devices.
  • Any behavior or possibility of behavior that will result in physical, psychological, social or emotional harm to another is unacceptable. Below are some specific examples of behaviors that should be avoided:
  • Hitting, pushing, kicking, tripping, spitting
  • Initiating or spreading rumors/gossiping/sharing unnecessary information about others
  • Bullying
  • Instigating a fight
  • Unacceptable bus behavior
  • Stealing or blackmail
  • Use of a weapon
  • Use verbally or written words like: kill, shoot, pop, sniper, or anything that resembles these words

Students should also:

  • Follow directions of any staff member the first time they are given.
  • Keep hands, feet, and objects to yourself, even when playing around. No roughhousing.
  • Do not chew gum at anytime unless authorized.
  • Students should report at times given and follow field trip procedures set out by the person in charge.
  • Not bring any objects to school which could potentially be used as weapons or which resemble weapons.

Note: This list is not all inclusive; it is merely a sampling of some examples of inappropriate behavior.

Consequences:

  • Student could lose the privilege of future field trips of they do not obey the code of conduct/dress code.
  • Students could potentially lose other privileges or receive other consequences depending on behavior.
  • Administration reserves the right to administer ranging consequences based on various behaviors.

Students that acquire 12 or more points or are currently failing a class for the year will not be permitted to attend a field trip unless the field trip is deemed mandatory by the classroom teacher.

TOR/Lunch Detention/Wednesday Detention=1 Point

Friday Detention=3 Points

Saturday Detention=4 Points

Suspension=5 Points for each day suspended

If a student does acquire 12 points they may earn back one point for each week the student goes without any of the aforementioned infractions.