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Lowell High School Field Trip Notification Form

Student Name
House / Advisory Rm / ID
Field Trip Destination
Departure Date/Time
Return Time
Teacher/Advisor

Pollard Memorial Library


April 15, 2016 11:45 p.m.
1:40 p.m.
Matthew Brennan and Alison Gervais
Parent/Guardian Permission & Signature

Explain the trip: Visit to Pollard Library, obtain library card, tour of services and borrow a book.
P/G Signature: ___________________________________________________

Date: ___________________

Teacher Permission & Initials


This field trip has been arranged as part of the course content or activity at LHS for _____________________.
Please initial below to indicate if this student has permission to attend the field trip during your class. If this
student has excessive absences, or is in danger of failing, please indicate the reason for the denial of permission.
Period 4

__________

Yes _____

No _____

Reason ___________________________________

Period 5

__________

Yes _____

No _____

Reason ___________________________________

Period 6

__________

Yes _____

No _____

Reason ___________________________________

Period 7

__________

Yes _____

No _____

Reason ___________________________________

Commitment to excellence in everything we do: Academics, Activities & Citizenship.

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