Kinder and 1st Simple Machines at Work
Your child is eligible to participate in a school-sponsored activity requiring transportation to a location away from the school building and grounds. This activity will take place under the guidance and supervision of employees from St. Mary’s Catholic School.

A brief description of the activity follows: Students will travel to the CAC for a presentation on simple machines at work.

Name of Event: Simple Machines at Work
Designated Supervisors of Activity: Mrs. Rockwood
Date of Field Trip: Tuesday, January 29, 2019 12:30pm to 2:15pm
Location: Cultural Arts Center, 3011 N. 3rd St. Temple, TX 76501
Method of Transportation: Parent Drivers
Student Requirements: Students will wear SMCS school uniform
Cost: $3.00 per student and chaperone
Please respond by: Friday, January 25, 2019

By submitting this form you agree to this event. You give consent and release of liability. As Parent/Guardian you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named student.

In consideration for the making of the arrangements for this trip, I/We hereby release and save harmless the St. Mary’s Catholic School, all its employees and the Diocese of Austin from any and all liability arising to my child as a result of this trip. I also agree to allow my child to travel on this trip in a private vehicle.

If emergency treatment is required for my child, I/We authorize St. Mary’s Catholic School personnel to follow area EMS regulations in caring for my child.

If your child(ren) are 8 years or younger they are required by law to be in a booster seat.
You may NOT bring any siblings or child(ren) who are not St. Mary's Catholic School students.
We are blessed that many parents are able to help chaperone/drive, therefore we will contact you if we need you to chaperone.
Chaperones must be EIM Compliant.

Email address *
I/We, the Parent(s)/Guardian(s) of (child's name) ______________________ request that St. Mary’s Catholic School allow my child to go to the above mentioned event. *
Your answer
Parent/Guardian’s Electrionic Signature *
Your answer
Emergency Contact Phone *
Your answer
Drivers Needed (Must be EIM Compliant) *
Your answer
My car can hold XX students *
Your answer
Payment $3.00 per student *
Chaperone Fee $3.00 per chaperone *
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