Field Trip Permission Form
Parent Permission For School Sponsored Activities
And Consent to Medical Treatment

Please fill out one form per student

Child's Last Name *
Your answer
Child's First Name *
Your answer
Homeroom teacher *
I give permission for my child to participate in school activities that are off campus and away from the school premises. *
I understand that when my child is off campus to participate in a school activity, he/she is expected to abide by all school policies, procedures, and regulations during the course of the off campus activity. *
Required
I understand that in the case of serious illness or injury, or any other circumstance requiring medical treatment for my child, the school will notify me or the emergency contact listed. In the event of a medical emergency concerning my child at a time when either I or the emergency contact person cannot be notified, I hereby authorize a school official to procure any necessary medical care and/or treatment, including but not limited to first aid, X-Ray, examinations, and treatment or hospital care. I hereby accept the sole financial responsibility for such medical care and understand the Arts Based School will not have any financial obligation.
Please list any medical information we would need to know about your child during an off campus activity. (if none, write n/a) *
Your answer
Please list any food or drug allergies (if none, write n/a)
Your answer
Please list emergency contact information (Name, Phone Number, Relationship to student) *
Your answer
I am the parent and/or legal guardian of the student listed on this form. *
Please type the full name and email address of the person filling out this form. *
Your answer
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