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Student Permission Slip
Student Permission Slip

My/Our son/daughter__________________________________________ has my/our permission to attend all band sponsored trips and school approved functions, for the school year 2017-2018. Travel will be by School bus/Charter Bus or director/chaperone personal vehicle. While I/we realize that every precaution will be taken for the safety of the students, I/we understand all chaperones nor the Ysleta Independent School District will be held responsible in case of an accident. If an accident or sickness should occur, I/we authorize the school’s designated representative(s) consent to physician and/or hospital emergency medical and/or surgical treatment. It is understood that all cost of such treatment are my/our responsibility. It is further understood that school authorities will notify parents/guardians as soon as possible if an emergency arises, but in no way is treatment to be delayed until that time.

Student Name *
Your answer
My Son/Daughter may/may not swim *
My Son/Daughter may/may not be given Tylenol, ect. by chaperones *
Insurance Company *
Your answer
Policy Number *
Your answer
Prescription Medication (Please send extra medication for the chaperones in case the student misplaces theirs) *
Your answer
Medical Conditions: *
Your answer
Signature of Parent or Guardian *
Your answer
Address *
Your answer
Home Phone Number *
Your answer
Work Number *
Your answer
Emergency Number *
Your answer
For your protection please list the following information about your personal instrument
Instrument
Your answer
Brand
Your answer
Model
Your answer
Serial Number
Your answer
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