Date: _____________________

I give my permission for ________________________________ to leave the school
(Student Name)

building to go on a field trip. We will leave at _____________ and return at ___________.


We will be going to ___________________________ on __________________________.

It is understood that the school assumes no responsibility other than furnishing a teacher to accompany the group. I further agree that the teacher may authorize necessary medical treatment in the event of an accident or an emergency. Parents will be contacted as soon as possible.

_____________________________________
Parent or Guardian

______________________________________
Phone Number