Field Trip Student Information and Permission Form
Independent School District 196 - Rosemount, MN 55068
Student Name - First
Student Name - Last
As a parent of a member of the Eagan Speech Team, I give permission for my child to participate in a field trip to
Person to be called in case of emergency
(First and last name)
List any physical factors that should be know about this chid:
Medication student is presently taking:
I request that my child be allowed to self-administer this medication while on the field trip as prescribed by my child's physician/dentist.
In case of minor illness or injury, I give my permission for the supervisor of my child to administer necessary treatment and/or first aid.
Digital Signature of Parent or Guardian:
By entering your name in this box you are digitally signing this document.
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