Explorers' Winding Trails Field Trip ~ Permission Slip 2017
DESTINATION: Winding Trails; 50 Winding Trails Drive; Farmington, CT, 06032; (860) 677-8458
PURPOSE: Adventure Education (Activities planned at Winding Trails will focus on: getting-to-know each other; team building; trust; and communication to name a few.)
TIME OF DEPARTURE: 9:00 a.m.
TIME OF RETURN: 2:30 p.m.
COST: $25 (includes $19 for the programs at the facility ... low ropes and giant slide ... and $6 for bus transportation)

LUNCH MUST BE BROUGHT.

Email address
Please have your child return the ...
$25 PAYMENT TO HIS/HER HOMEROOM TEACHER BY MONDAY, 09/11/17
*Cash or Check made payable to "Middle School of Plainville."
Points to Consider
* If there is a financial hardship meeting the costs associated with this activity, please contact the team leader, Mrs. Buthe, at (860)793-3250, x1216, NO LATER THAN MONDAY, 09/11/17.

* No refunds will be issued once a financial commitment is made to attend. FYI: Payments for the facility, busses, etc... need to be made prior to the trip.

* Please review the “MSP Student Eligibility for School Sponsored Events” with your child which can be found in the Student Handbook as well as in the next section.

* The school system has the right to cancel any trip and will not be responsible for lost deposit money should the trip be canceled. All decisions will be made on a case-case basis.

* At Winding Trails, students will be participating in cooperation activities such as: large group games; individual group games; and problem-solving tasks on the low-ropes course. There are 25 tasks on the low-ropes course all together. We will participate in six (6) to eight (8) of them in our time at the facility, such as moving an “egg” safely up and over a rope net.

*Go to www.windingtrails.org for more information.

MSP Eligibility for School-Sponsored Events
Please review the following with your child, as stated in the Student Handbook:

Curriculum Related Trips:
*In the event a child is assigned ISS/OSS on the scheduled day of any school-sponsored trip or activity, the child will be required to serve the assigned consequence and will not be eligible to participate in the activity.

*If a child has a repeated pattern of unacceptable behavior or is considered a potential safety risk for a curriculum-related school event, the administration and teachers will confer with the parents before eligibility is determined.

Parents/Guardians: Please complete the following information:
My child has permission to attend the following Grade 6 trip (Check only 1.):
Required
Student's LAST Name (Ex.: Buthe)
Your answer
Student's FIRST Name (Ex.: Melinda)
Your answer
GUARDIAN 1 CONTACT INFORMATION:
Guardian 1 Full Name (Ex.: Melinda Buthe)
Your answer
Guardian 1 Home Phone Number (Ex.: 999-999-999 or none)
Your answer
Guardian 1 Cell Phone Number (Ex.: 999-999-999 or none)
Your answer
GUARDIAN 2 CONTACT INFORMATION:
Guardian 2 Full Name (Melinda Buthe)
Your answer
Guardian 2 Home Phone Number (Ex.: 999-999-999 or none)
Your answer
Guardian 2 Cell Phone Number (Ex.: 999-999-999 or none)
Your answer
EMERGENCY CONTACT INFORMATION
Person best to contact in the event the parents cannot be reached.
Emergency Contact's Full Name (Ex.: Melinda Buthe)
Your answer
Emergency Contact's Home Phone Number (Ex.: 999-999-999 or none)
Your answer
Emergency Contact's Cell Phone Number (Ex.: 999-999-999 or none)
Your answer
HEALTH INFORMATION/EMERGENCY TREATMENT WAIVER
NOTE: If your child is on medication during the school day and is going to need medication during the field trip, you, the parent/guardian, MUST contact the school nurse TWO WEEKS IN ADVANCE OF A DAY TRIP and THREE WEEKS IN ADVANCE OF AN OVERNIGHT TRIP to make arrangements for the administration of the medication.
Health Insurance Information ~ Plan Name (Ex.: Anthem BCBS)
Your answer
Health Insurance Information ~ Plan ID# (Ex.: ABC999999999)
Your answer
Medication(s) needed during field trip (Please write “NONE” if your child does not need any medication on the field trip.)
Your answer
Known Allergies ~ food, environmental, medication, etc. (Please write “NONE” if your child does not have any allergies.)
Your answer
Does your child have asthma?
If you answered "YES" to the above question, please describe the treatment/special instructions:
Your answer
PARENT/GUARDIAN PERMISSION
I will hold harmless the school, its agents, directors, employees, teachers and school officials for any financial liability or obligation which my child personally incurs, or injury or damage to the person or property of others which my child causes or contributes to while participating in this trip. I understand that my child is responsible for exercising caution and common sense at all times to avoid injuries. In case of a medical emergency, I hereby give permission to the chaperone to select a physician or hospital and secure proper treatment for my child.

I hereby relieve the school district of any responsibility for damage or loss to my child’s personal property.
Should world/national events require cancellation of this field trip, the Board of Education is not responsible for lost deposits. I certify that I have read the information above, that all of the above information is correct, and that my child has my permission to attend the field trip described above.

By signing below, I affirm, understand and agree to the above terms in their entirety.

Parent Full Signature (Please type full name - Ex.: Melinda Buthe)
Your answer
Date of Signature
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This form was created inside of Plainville Community Schools. Report Abuse - Terms of Service - Additional Terms