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BRUNSWICK ZONE XL Student Contract
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BRUNSWICK ZONE XL Student Contract         Student: ___________________________        

Parental Consent to participate in a Field Trip        Cell# _____________________________

October 19, 2016 __________        (6TH & 7TH)                Parent Name________________________

November 9, 2016 _________        (8TH & 9TH)                Parent Cell # _______________________

This Brunswick Trip is organized by a team of teachers of Winfield Middle School, for their students during the school year. Their extra efforts throughout the year and on the 2016 MAP test have motivated them to organize this trip. Students earning Advance, Proficient or increased their score category will also be invited.  There will be some procedures we will need to follow if we are to have a successful venture that day.  We will review them here.  This agreement, when signed and initialed, informs those concerned that the following stipulations are understood and agreed upon before departure and that Winfield School District is authorized to take approved students on the aforementioned field trip.  

PLEASE INITIAL EACH LINE OF TERMS AND CONDITIONS BELOW.

1.   Brunswick has agreed to open for us that day.  We will require about 0.25 hours travel time.  We will have to leave at 9:30 am and we will depart Brunswick about 12:00 pm.  Students will return to school and be responsible for any work they missed while away from classes.  _______

2. This signed slip is considered parent permission for Winfield School District to transport the student to Brunswick XL Zone in O’Fallon for the published trip.  Middle School students will return their forms to Coach Rodgers or Coach Stokes. High School students will return theirs to the Main Office. Forms are due one week before the planned date of the trip._______

3.  All established District and Building policies will be followed.  Additional parameters may also be added at sole direction of the sponsors.  Violations will result in disciplinary actions as deemed appropriate by District or Building._______

4.   This agreement is meant to alleviate any misunderstanding that this trip is merely a vacation or party.  On the contrary, it is an opportunity for students to experience concrete demonstrations of mathematical, educational and scientific principles in a meaningful and enjoyable way._______

5.  I, the undersigned, am the parent or legal guardian having custody of above mentioned student who attends Winfield School District.  I hereby give my permission to said son, daughter or ward to participate in an off-campus field trip._______

6.  I understand that Winfield School District does not purchase, or have, medical/ dental/ hospitalization insurance to cover injuries to or loss of life of students and to indemnify district for expenses in connection therewith and that such insurance, if desired, must be purchased by the parent or guardian.  I understand that all persons making the field trip shall be deemed to have waived all claims against the district or sponsors to injury, accident, illness or death occurring during or by reason of the field trip. _______

Parent Signature                                                               Emergency Number

Parents Name                                                                                  Date Signed

Parents Address

Next to Notify                                                                    Emergency Number

Doctor’s Name                                                                       Doctor’s Number

Please list any medication currently prescribed or routinely taken and any other important medical information such as bee sting allergies etc.