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PINELLAS COUNTY SCHOOL

FIELD TRIP/ACTIVITIES PERMISSION FORM

 

 

School

 

Pinellas County

Schools

 

 

 

 

 

 

 

 

I (We) hereby grant permission for

 

to participate

 

 

 

Student Name

 

 

 

In a field trip/activity to

 

on

 

 

 

 

Location

 

Date

 

 

And to make incidental stops en route and return as may be desirable or necessary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Students will be traveling the following manner:

 

 

 

 

 

 

  Walking

  Rental Vehicle

 

 

 

 

  School Bus

  Commercial Transportation Carrier

 

 

 

 

Private Passenger Vehicle

  Other

 

 

 

 

 

 

(Parents of high school students are reminded that trips in private passenger

vehicles sometimes involve the use of school age drivers)

 

 

 

 

 

 

Time of Departure (Approx.)

 

 

Time of Return (Approx.)

 

 

 

1)

I authorize school representatives to obtain medical treatment for my child in case of serious illness or injury and agree to pay for such treatment.

 

 

2)

I understand that the trained school employee who usually dispenses medications may or may not be present during this trip. Medications will be dispensed by a responsible staff member.

 

 

3)

I have documented below all precaution/instructions regarding my child’s medications. I have noted any special health-related conditions or allergies regarding my child.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4)

All provisions of the student code of conduct apply to field trips and activities. To ensure student safety and compliance with the student code. I agree that my child’s luggage, belongings, and rooms (where applicable) may be randomly searched for contraband.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Parent/Guardian

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alternate Emergency Contact

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PCS Form 3-2718 (rev 8/00)

Review Date 8/01

 

 

 

Category Y

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