Contact Information Sheet

Name of Student: ______________________________________________________________________

While there is a expectation that we will never need to make a phone call on the trip concerning your student, we also know that unexpected things can occur and we would like two people that will be available during the week of Feb 11 – 17h that have authority to make decisions concerning your child.

Primary Contact from February 11 – 17

Name: __________________________________________________________________________________

Telephone Number: _______________________________ Best Number

Telephone Number: _______________________________ Second Best Number

Secondary Contact from February 11-17

Name: _________________________________________________________________________________

Telephone Number ______________________________ Best Number

Telephone Number ______________________________ Second Best Number

______________________________________________________                ___________________________
Parent Signature                                                Date

My student is allowed to take the following medications as needed.

___ Dramamine
___ Robitussin
___ Ibuprofen
___ Pepto Bismol
___ Tylenol

_______________________________________________________                _____________________________
Parent Signature                                                Date