AVIANO ELEMENTARY SCHOOL

STUDY TRIP PARENTAL PERMISSION FORM

STUDY TRIP TO: Lazzarotto Farm: Making Instruments from Wood

Teacher: Peige Rosales and Jillian Gooch
Date of Trip: 19 November 2014
Departs at 08:15 Returns no later than 13:30
Student needs for this trip:
Money: 7.00 delivered to school by 19 November 2014
Sack lunch, including water/juice
Special Clothing: (umbrella, rain boots, coat, hat, mittens, etc.)
Please retain the above information. Return bottom portion to school along with 7.00 on or before 19 November 2014.

NAME OF TRIP: Lazzarotto Farm: Making Instruments from Wood

Date: 19 November 2014

It is imperative that accurate information be provided in the event that a parent/sponsor

must be contacted because of an emergency during this study trip.
Student Name:
Sponsors Name & Rank:
Sponsor Duty Phone #: _____________ Home Phone #: ___________
Spouse Duty Phone #: ____________________
Emergency Contact: _______________ Phone #: ____________
____ _____ Permission is given for my child to participate in the study trip.
YES
NO
CHAPERONES
Chaperones are limited, due to the size of the venue. If you are interested in entering our
Chaperone Raffle, please complete the form on our classroom website:
http://rosales.aes.mdso.eportalnow.net/, or contact Mrs. Rosales via email by Sunday, November 9.
We will draw three names and notify the chaperones on Monday, November 10.
I understand that verbal consent/phone calls will not be accepted, and that my signature
on this form is required for my child to participate.
_______________________________________
Signature of parent/guardian/sponsor
Reference: DSG Supplement to Section 208 of DS Manual 2005.1. Since sponsors and chaperones are to devote fulltime supervision to the students under their care, it is inappropriate for family members to participate in, travel with, or
join the group at their destination.
INFORMATION CONCERNING STUDENTS WHO DO NOT GO ON STUDY TRIPS:
1. If an entire classroom goes on a trip, the student will go to another classroom.
2. If a part of a classroom goes on a trip, the student remains with the part of his/her class that does not go on the trip.