Field Trip Permission Form

Quail Valley ACKNOWLEDGEMENT OF RESPONSIBILIry AND PERMISSION FOR STUDENT PARTICIPATION IN SCHOOL.SPOTVSCiNED TRIP

Student Name: School-sponsored trip to: Your chird has the opportunityto participate in a schoor_sponsored trip. prease comptete this form to provide-the ieachd; the students on the trip with information relating to your child.

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Teacher:

Date:

List any physical limitations (temporary or permanent): List any current medications (prescribed or over the counter) taken: List any allergies incruding reactions to medications, food, insects, and environment: Name of child,s physician:

Phone:

lnsurance company:

Phone:

Policy Number: ACKNOWLEDGEMENT OF RESPONSIBTLIry My signature below indicates that I giv.e.!y child permission to participate in this activity, to have any medications ao-ministered tdt schoor, and that t authorize any needed emergency w;;rd normaly be given at medicar treatment. rarso acknowledge that I have been informed that glnd Independent School ro.t District has immunity from any tiability. Transportaiion wirr be provided by the District or a commercial carrier.

Parent Signature:

Date:

Address: Home Telephone:

Work Telephone:

Emergency contact person:

Fort Bend Independent School District . 3500 euail Village Drive r (281) 634-5040. Fax {281) 634-5054

Phone No:

o Missouri City, Texas 77459