Generic Permission Slip

I give permission for*

Student's name

First Last

to go to (location) on (date) and return ()

Grade*

Please check one of the following:

(even if your child is on free or reduced lunch) Sack lunch orders need to be in no later than Monday, November 14, 2017

My child will purchase a lunch from Nutrition Servides
My child will bring their own lunch from home

PARENT/GUARDIAN AUTHORIZATION

I understand this trip is an optional activity and attendance by my student is not required. An alternative activity at school will be provided if I do not give permission for my student to participate. Your child will join another class, either a grade level older or younger depending on an appropriate level of instruction.
I understand all students going on the trip will be responsible in conduct to the supervisors and are subject to all rules and regulations of the School and Bend-LaPine Schools.
I understand students are required to go and return from this event on the transportation provided unless prior arrangement has been made and agreed to in writing by the School administrator or teacher. Trips begin and end at the School of origin or designated location.
I understand there will be times during the trip when an adult may not accompany my student or the ratio of students to adults may be more than 10 to 1.
I hereby acknowledge I have been advised activities involved with some trips may be inherently dangerous.
I understand there is no insurance provided by the School or District for this trip although the District has made student accident insurance available for purchase at my own expense.

Authorization to treat minor: In the event I cannot be contacted, I hereby give permission to the School staff to secure proper treatment for my student and agree to be financially responsible for any expenses incurred for any necessary treatment resulting from this trip. I have read and understand the trip information materials.

Parent/Guardian Phone*

Alternate Phone

Emergency Contact*

First Last

Emergency Contact Phone*

List any medical needs or conditions of student

Signature*

Phone

This field is for validation purposes and should be left unchanged.