7th Grade Six Flags

Math and Science Day Field Trip
Friday, May 13, 2016

Student Name_________________________________
Science Teacher________________________________
We are happy to announce that the 7th graders are invited to attend a field trip on Friday, May
13, 2016, to Six Flags Over Georgia for Math and Science Day. We will leave the school at
approximately 9:00 am and will return back to school around 7:00 pm that evening. It will be the
responsibility of the parent/guardian to make certain that your child is picked up from the school
when we return.
The cost of the trip is $55.00 (payable with cash, check, or money order) for students and
chaperones which includes: admission into Six Flags, a catered lunch which includes a sandwich,
chips, cookie, fruit, and drink, a FREE Bounce Back ticket to Six Flags White Water (valid through
June 30, 2016), and transportation. Any other food/drink, game, locker, photo, or souvenir
purchases will be the responsibility of the student. 2016 Six Flags Season Passes CANNOT be
used for this event.
Any student receiving an office referral resulting in ISS or OSS, from the date of this
permission slip (2/8/16) until the day of the field trip (5/13/16), will not be eligible to
attend and will only receive a full refund as long as the spot can be filled by another
student. Students not attending the field trip will have a normal school day.
We will need chaperones for this trip, so if you are interested, please fill out the information on
the back of this form, and email Ms. Foster (mfoster@henry.k12.ga.us) ASAP so that you can
complete all required paperwork prior to the field trip. ALL chaperones must have a current
background check in place and must sign the Mandated Reporter form. All chaperone paperwork

must be received no later than Friday, April 22, 2016, in order to be processed in time for
the field trip. Chaperones must be 21 years of age or older.
All money and forms should be returned to your child’s science teacher. Please fill out the
information on the back of this form and return with your payment. If sending a check as
payment, the following must be on the check: Name, current address, current phone
number. Please also include the student name and “Six Flags” on the memo line. Feel free
to make payments until the trip is paid in full; however, final payment must be completed by
Friday, April 22, 2016 – NO EXCEPTIONS!
If you have questions, please contact Ms. Foster at mfoster@henry.k12.ga.us or 770-957-6055.

Teacher/Grade: Foster/Franko/Heath/7th Grade Science
Departure Date/Time: Friday, May 13, 2016 @ 9:00 am

Destination: Six Flags Over Georgia
Return Date/Time: Friday, May 13, 2016 @ 7:00 pm

Donation Amount: $55.00 per student or chaperone (no student will be denied access to a field trip for monetary
reasons; however, if donations do not cover the cost of the trip, the outing may be cancelled).
Chaperones Requested:
Yes __X___
No ______
Lunch: Lunch is provided in the cost of the field trip
Transportation will be provided by:
HCS bus transportation
To be filled out by parent/guardian

Please complete and return by: Friday, April 22, 2016

Student Name: _________________________________________________________________________

My child has permission to attend the field trip.
My child does not have permission to attend the field trip.
I would like to be a chaperone

***Chaperone paperwork is due by Friday, April 22nd - all chaperones must be 21 years of age or older***
Contact # __________________________________________________________________

My child has medication which should be administered during this trip.
Please provide the following:

Name of medication:____________________________________ Dosage:____________________________
Parent name:__________________________________________ Contact #:_________________________
Emergency Contact Information: Please provide two different contacts in the event of an emergency:
Contact 1 Name:_______________________________________ Contact #:__________________________
Contact 2 Name:______________________________________ Contact #:__________________________
If any emergency medical procedure/treatments are required by the student during the trip, I consent to the trip’s
supervisor taking, arranging for, or consenting to the procedures or treatment at his or her discretion. I further
release and waive any claim which I or any other person, firm, corporation, or entity may have or claim to have, known
or unknown, directly or indirectly, from any losses, damages or injuries arising out of, during, or in connection with the
student’s participation in the activity, any trip associated with the activity, or the rendering or emergency medical
procedures/treatment, if any. I further agree to indemnify and hold harmless and reimburse the Henry County
School District, the Board of Education, its successors and assigns, its members, agents, employees, and
representatives thereof, as well as the trip supervisor from and for any and all claims and losses.

Signature(s) of Parent(s) or Guardian(s)