SCHOOL DISTRICT OF CLAY COUNTY

FIELD TRIP PERMISSION FORM-ELEMENTARY

By signing this form below I agree to the following:

1. My child,___________________________has permission to attend the field trip to

             First Baptist of Orange Park on Tuesday, May 16th from 9:15am to 12:00pm.

Permission slip, bus money, and food money is due on MONDAY, MAY 8TH.

2. My child has permission to be transported by either school bus, charter bus or

private vehicle.

3. In case of medical emergency the teacher has permission to seek medical care for my child and I consent to any treatment necessary. I will be responsible for the medical bills.

4. I will pay the cost for the trip which is $5.00 (for bus fare). I will not be entitled to a refund for any reason. PLEASE ENCLOSE YOUR CHILD’S FOOD MONEY WITH YOUR BUS MONEY IN THE SAME ENVELOPE WITH YOUR CHILD’S NAME AND HR TEACHER’S NAME. I will not be entitled to a refund for food for any reason.

5. All physical conditions that my child suffers from are listed on the bottom of this form.

6. My child is healthy enough to participate in this activity without limitation.

7. In the event of motor vehicle accident I will file medical bills with my own insurance.

8. I release the School Board of Clay County from any liability for injury to my child which occurs on this field trip.

9. My child will be under the supervision of school personnel or approved volunteers.

________________________________ _______________________________

Parent’s Signature/Date Phone number (s)

_________________________________ ________________________________

Parent’s name printed Child’s name printed

IMPORTANT: PAYMENT AND SIGNED PERMISSION SLIP MUST BE RETURNED TO THE TEACHER BY MONDAY, MAY 8TH. YOUR CHILD WILL NOT BE ABLE TO PARTICIPATE IF THIS FORM IS NOT ON FILE WITH THE SCHOOL.

PHYSICAL CONDITIONS: (PLEASE LIST IF ANY)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

INS 2-3600 E. 05/01/2018

TURN OVER FOR FOOD ORDER