Field Trip Permission Slip Brentwood Union School District 255 Guthve Lane Brentwood, CA 84513 schoo! Name: Edna. HLL. Teacher Name: My child has my permission to go on a school sponsored field trip to_ My so100 Spr nays on Sepr Gall, 2S (1 Yes No This trip includes swimming. If yes, indicate student's swimming abilty in Yes Regular doctor: [] cera pases re eee Peanut Butter & Jelly or Deli Sandwich (circle choice) fruit, juice, crackers & milk Phone: _ ‘Medical insurance: _ a Policy [Phone contact during time of trip: C_) Name of person: _ ]teme [| Faber Mother Oiher work ‘wore ) Name of person: _ aoa L Father — work ‘work If unable to contact parent/guardian above, you may call at In the event of illness or injury, I give the teacher in charge the authority to obtain immediate medical attention. ‘do hereby consent to whatever ay, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital cate are corsicered necessary in the best judgment of the attending physician, surgeon, or dentist and performed by or under {he supervision of a member ofthe medica sat ofthe hospital or facility funishing medical or dental services, Medications to be taken on trip: Al medications, excepting those which must be Kapl on The Stade and cistrbuted by the stall ‘parson Tor emergendy Use, MUST Be kept Medical conditions staff should be aware of: (ie. Medications child may be allergic to, etc) A sate n Cater Eaton Cade secon 3590, undorsard that | ole Bentwood Union Scheel Ose s afcors, agents, and employees harmless trom ary ara aby or Cams, which may arse out of in sonnocae thm child's partcipation in this activity. "v u : Sel | fully understand that parteipanis are to abide by ll rules and regulations governing conduct during the tip. Ay voation of ese rules and equations may rest in that indvidual Doing sent home al ihe expense of risther parertiguaddian Pavent Sigraare one