Minford Local School District
Field Trip Permission Form

This form must be filled out and returned to school before the student will be permitted to participate in the field trip.
 

Student's Name_____________________________ Birthdate ___________________ Grade__________
Field Trip to ________________________________ Field Trip Date ______________________________
Sponsor ___________________________________ Field Trip Hours ____________________________

I hereby give my permission for ________________________________________________ to go with the

______________________________ class to _____________________________ on ______________.

I understand that my child will be expected to observe the rules and regulations as per school policy.

____________________________________
Signature of Parent of Guardian
 _____________________________________
Date
Emergency Medical Information
In case of emergency, please contact _________________________ at ______________
Contact Person's Name & Phone Number
If first contact cannot be made, please contact _________________________ at ______________
Alternate Contact Person's Name & Phone Number

If none of the above contact attempts are successful, please transport my child to

________________________________
Hospital Name
 and contact Dr. __________________________
Physician's Name
or Dr. ___________________________.
Dentist's Name

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

Facts concerning my child's medical history including allergies, medications being taken, and any physical impairment to which a medic should be alerted are listed below:
 

____________________________________ _____________________________________

____________________________________
Signature of Parent or Legal Guardian
_____________________________________
Date

If you do not want to above procedure performed, please check here ______ and state the procedure you want followed:
 
____________________________________ ____________________________________

____________________________________
____________________________________

 
____________________________________
Signature of Parent or Legan Guardian
 ____________________________________
Date