Fall Rally Permission Slip

0,,* 'ikr/uf MONTVILLE TOWNSHIP SCHOOL DISTRICT FIELD TRIP PERMISSION FORM

Dare:

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Your child has the opportunity to attend the following school-sponsored field trip. please complete Sections B and C and return this form with a check made payable to tne School Student Activity Account,

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Sincerely,

"fu,*, r/ f*.oo.Z€r' Seclion A, Field Trip lnformation

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f€a Dateorrrip: taltrl o1 Field Trip Destination:

Time of

Departure:

cost Per

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e_

Time of

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stuoent$tf,S

Return:

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Section B. Medical lnformation

My child suffers from the following potentially life-threatening condition(s):

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Asthma

I

rutergy to Food or Bee Sting

f

Diabeies

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lr/y child is capable of self-administration and proper documentation is on file in the nurse's office.

f

t witt

f

t witt contact the

accompany my child on this trip because of his or her medical condition.

school nune immediately if either of the above two options cannot be met.

Parents must contact the school nurse to discuss any health or medical issues concerning their child before the child is permitted to attend the field trip. Please list all known medical conditions:

It is highly recommended that students needing medication for life-threatening conditions be accompanied by a parent or iegal guardian or be capable of self-administration of medication for the condition.

Section C. ParenUGuardian Permission Student Name:

Grade:

I hereby give my child permission to attend the field trip as indicated in Section A above.

Signature of ParenVGuard ian

Date Revised 1-26{9

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