FIELD TRIP PERMISSION SLIP

University of Houston
Wednesday, March 24, 2010
Where: University of Houston
When: Wednesday, March 24, 2010 from 7:00 am to 2:30 pm
Who: AVID Students
Why: To learn more about University of Houston , experience a college tour
and talk to an admissions administrator.
Lunch: Students should bring a bag lunch/drink or money for lunch.

I, ___________________________________________________ (parent name) give my

permission for ________________________________________________ (student name)
to go to the University of Houston on Wed. March 24, 2010. I understand that
my child will be fully responsible for any assignment that may be missed during
the day.
My child will be responsible for bringing their lunch or lunch money.

Parent Signature ______________________________________________________

Date_____________________________________
Student Signature______________________________________________________
Date_____________________________________
Emergency Contact Number ___________________________________________

Humble ISD Insurance Acknowledgment

I certify that I am the parent/guardian of: ________________________________________

Student name
( ) He/she is enrolled in the school insurance program.
( ) He/she is covered under my family policy with:

________________________________________________________________________________
Insurance company Policy/Group number

Medical Information sponsoring teachers need to be aware of:

Medication__________________to be given at______________________.

Allergies__________________________________________________________

Comments_______________________________________________________
I give my consent for an agent of the school to acquire emergency medical attention
for my son/daughter_____________________________________________ and I assume
responsibility for payment.

____________________________________________ ____________
___________________
Signature Parent/Guardian Date Witness Signature
________________________________________ ______________________ _______________
Address Phone Emergency #