Madison Middle School Field Trip Permission Slip ~ U of O Basketball Game
Dear Parent:
In connection with their class instruction, students make planned trips to different places of educational value. These trips are planned so that students may learn under the direction supervision of their teacher and other adults associated with the trip. We are pleased to be able to offer the following trip to your student.

Field Trip Permission
I hereby give my permission for my student (name included below) who attends Madison Middle School to participate in a field trip to the Matthew Knight Arena on Monday, December 16, 2019 from 10:30am-3:30pm. Students will be watching a a University of Oregon Women's Basketball game. Students may bring a lunch or order a school lunch to eat at the arena.

Please complete the form below to give permission for your student to attend the field trip. Students must have a completed digital or paper form to attend the trip. Thank you!
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Grade *
Informed Consent
As the parent/guardian of the above named student, I have read the field trip itinerary and I understand that there are risks of physical injury associated with participation in these activities.

I authorize qualified emergency medical professionals to examine, and in the event of injury or serious illness, administer emergency care to the above named student. I understand every effort will be made to contact me to explain the nature of the problem prior to any involved treatment. In the event it becomes necessary for the school district staff-in-charge to obtain emergency care for my student, neither he/she nor the school district assumes financial liability for expenses incurred because of the accident, injury, illness, and/or unforeseen circumstances.

These activities are an extension of the school education program and student conduct is to be in accordance with the school's published rules and regulations.
I give my permission for my student to attend this field trip. *
First and Last Name of Parent/Guardian *
Your answer
Parent/Guardian Phone Number (to use if needed on field trip day) *
Your answer
We will have lunch at the game. Students may bring their own lunch or order a school lunch. Do you need a school lunch? *
Student Conduct Agreement
**Please read and discuss this part with your student.** I pledge that my conduct will, at all times, reflect credit upon myself, my parents/guardians, and my school. I understand the school rules of conduct apply while on the trip.

I understand that in the case of serious violation of the rules outlined in the Student Rights and Responsibilities Handbook, that my parent(s)/guardian(s) will be called and that I will be sent home at their expense.
I agree to abide by the student conduct agreement (student types their first and last name). *
Your answer
I affirm that entering my name and submitting this form constitutes an electronic signature of this form.
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