Parent Permission Form

I give __________________________ my permission to attend the Music Retreat at the

University of Regina on Tuesday, September 30th, 2014. The students will be traveling by
bus to and from the event.
__________________________

________________________________

Date

Parent/Guardian Signature

Students Cell Phone: __________________________________________________

Parents Names: ______________________________________________________
Parents Email Address: ________________________________________________
Home Phone #: ______________________Work Phone #: ____________________
Phone Number in Case of Emergency: ____________________________________

Medical Information
Students Age: _______________ Dietary Restrictions: _____________________
Doctors name and phone number: _______________________________________
Saskatchewan Health Number: __________________________________________
Medical History (conditions of which school personnel should be made aware)
____________________________________________________________________
____________________________________________________________________
Is the student taking any medication with them on this trip? (Name of medication)
____________________________________________________________________

**Should emergency services be required for your child during the trip, the local
personnel will be contacted immediately.