Permission Form

McCANTS MIDDLE SCHOOL

PARENT/GUARDIAN FIELD TRIP PERMISSION FORM

My child,__________________________, has my permission to

(First and Last Name)

attend the field trip to____Greenville Peace Center_____

(Location)

on__2-10-08_____with_Patrick Murch________.

(Date) (Teacher – First and Last Name)

I understand the trip will depart from_____McCants Middle______________

(Location)

at___1:50pm__and will return to_____McCants Middle_______at___5:45pm__.

(Time) (Location) (Time)

I give the teacher or administrator in charge of my son/daughter

limited power of attorney to act in my absence to see that my

child,_____________________, receives medical treatment as necessary

in case of sickness or accident. I also give permission for my child’s

medical information to be released in case of sickness or accident.

I understand if my child is involved in a discipline

problem, the school will handle the matter upon returning to

school. If a serious problem should occur while on an overnight

trip, I understand that my child will be dealt with according to

school and district policies.

I have read the above information and fully understand and

agree with the content.

Parent / Guardian Name__________________________________________

(Please Print First and Last Name)

Signature of Parent/Guardian____________________________________

Date____________Home Phone_______________Work Phone_____________

Emergency Contact Person________________________________________

Emergency Phone Numbers__________________ ________________

Please List All Medical Conditions Such as Asthma, Diabetes,

Allergies,etc.______________________________________________________

____________________________________________________________________

_______________________________________________________________.

My Child Is Taking The Following Medicines – Please list name of

medication, amount taken and times take_________________________

________________________________________________________________

_______________________________________________________________.

My Child is Allergic To The Following Medicines:________________

________________________________________________________________

_______________________________________________________________.

McCants Orchestra