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 Warehouse #98029