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SCHOOL DISTRICT OF CLAY COUNTY
FIELD TRIP PERMISSION FORM-ELEMENTARY
By signing this form below I agree to the following:
- My child,___________________________has permission to attend the field trip to
First Baptist of Orange Park on Wednesday, May 23rd from 9:15am to 12:00pm. Permission slip, bus money, and food money is due on MONDAY, MAY 21st.
- My child has permission to be transported by either school bus, charter bus or
private vehicle.
- 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.
- 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.
- All physical conditions that my child suffers from are listed on the bottom of this form.
- My child is healthy enough to participate in this activity without limitation.
- In the event of motor vehicle accident I will file medical bills with my own insurance.
- I release the School Board of Clay County from any liability for injury to my child which occurs on this field trip.
- 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 21st. 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
STUDENT NAME:______________________HR:_____________
LITTLE CEASARS PIZZA MENU
- DIRECTIONS: Please circle either CHOICE A, CHOICE B, CHOICE C, OR CHOICE D for what type of pizza and how many slices you would like. Please enclose your money for your food and bus fare in the same envelope with your child’s name and HR teacher.
ATTENTION: This vendor may use peanuts or have foods that are manufactured where peanuts are processed. If your child has a peanut allergy, please send a bag
|
CHOICE A FOR LITTLE CEASARS |
CHOICE B FOR LITTLE CEASARS |
|
1 SLICE OF CHEESE PIZZA with bottled water—$2.00
|
2 SLICES OF CHEESE PIZZA with bottled water—$3.00 |
|
CHOICE C FOR LITTLE CEASARS |
CHOICE D FOR LITTLE CEASARS |
|
1 SLICE OF PEPPERONI PIZZA with bottled water—$2.00 |
2 SLICES OF PEPPERONI PIZZA with bottled water—$3.00 |
Cost of gas for CCSD school bus = $5.00 per person Cost of gas for CCSD bus = $5.00
Cost of CHOICE A LUNCH = $2.00 NO PIZZA = $0.00
__________________________________________________ ________________________________
TOTAL = $7.00 TOTAL = $5.00
Cost of gas for CCSD school bus = $5.00 per person
Cost of CHOICE B LUNCH = $3.00
__________________________________________________
TOTAL = $8.00
Cost of gas for CCSD school bus = $5.00 per person
Cost of CHOICE C LUNCH = $2.00
_________________________________________________
TOTAL = $7.00
Cost of gas for CCSD school bus = $5.00 per person
Cost of CHOICE D LUNCH = $3.00
__________________________________________________
TOTAL = $8.00
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