Field Trip Permission Form

[Your Name] [Room number] [Email] [Telephone]	Where: [Destination] When: [Date], [time from-to]

Please return this permission slip by [click arrow to select a date].

I give permission for my child	to attend the field trip to [Destination] on [Date], [time from-to].

Please send [$ fee amount] (exact cash or check made payable to school) with this permission form.

I am:	☐ able to chaperone	☐ unable to chaperone

Special instructions for my child:

Emergency contact:

Name:
Phone:

In case of an emergency, I give permission for my child to receive medical treatment.

Parent/Guardian signature	Date