Field Trip Student Information and Permission Form
Independent School District 196 - Rosemount, MN 55068
Student Information/Permission
Student Name - First *
Your answer
Student Name - Last *
Your answer
Grade *
As a parent of a member of the Eagan Speech Team, I give permission for my child to participate in a field trip to *
Required
Emergency Information
Person to be called in case of emergency *
(First and last name)
Your answer
Telephone Number *
Your answer
List any physical factors that should be know about this chid:
Your answer
Medication Information
Medication student is presently taking:
Your answer
How Often?
Your answer
Reason:
Your answer
Signature
Digital Signature of Parent or Guardian: *
By entering your name in this box you are digitally signing this document.
Your answer
Date *
MM
/
DD
/
YYYY
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