Permission Slip

Permission Slip

This form is required for participation in the upcoming school field trip. Please complete all sections and return the form by the due date provided by the school. Failure to submit the form on time may result in your child being unable to attend.

Prepared By: [Your Name]

School Name: [Your Company Name]

Participant Information

(Please complete in full)

Student Name:

Grade:

Homeroom Teacher:

Parent/Guardian Information

(Primary contact details for communication and emergencies)

Parent/Guardian Name:

Phone Number:

Email Address:

Medical Information

(Please provide any relevant health or medical information)

  1. Does your child have any medical conditions we should be aware of during the trip?

    • No

    • Yes – Please specify:                                                             

  2. Does your child have any known allergies (food, medication, environmental, etc.)?

    • No

    • Yes – Please specify:                                                             

  3. Will your child need to take medication during the trip?

    • No

    • Yes – Please list medications and dosage instructions

Emergency Contact Information

Emergency Contact Name:

Relationship:

Emergency Phone Number:

Transportation Information

(Please check one)

How will your child be transported to and from the field trip?

  • By school bus

  • By private vehicle (must complete additional release form)

  • Other (please specify):                                                             

Permission and Release of Liability

By signing below, I, the parent/guardian of the named student, acknowledge that:

  • I've reviewed the field trip details, activities, and risks.

  • I grant permission for my child to attend and participate in the field trip.

  • I release the school, its employees, and any designated volunteers from any liability, except in cases of gross negligence, for incidents that may arise during the trip.

  • I understand that I am responsible for any medical expenses that may occur in case of an emergency involving my child.

  • I have provided accurate and current medical information regarding my child.

  • I grant permission for my child to participate in this field trip.

  • I understand and agree to the release of liability.

  • I have provided accurate medical information.

Signature

[Parent's Name]

[Date]

School Use Only

(To be completed by the school)

  • Trip Date:                                                            

  • Trip Destination:                                                            

  • Chaperones:                                                            

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