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72-03-34 4/21/08

Santa Rosa County School District
Authorization for Student Participation in a Field Trip School Name: Hobbs and King Middle School
Trip Name: Milton City Singers Chorus Destination: Bagdad Elementary School Music room Date of Trip: Every Thursday(school day) beginning September 6, 2012 Mode of Transportation: Bus to Bagdad ES, Parent/guardian is responsible for transportation to home. Estimated Time of Departure:_2:30pm bus will leave middle school. Students must be picked up:_4:30pm__- parent pick up is on Forsyth Street to the right of the front of the school.

****Parents, please complete all of the following information:****

Student’s Name:___________________________

School Name:______________________

Name of Parent/Guardian:__________________________Phone Number:_______________
A. Parent/Guardian Permission I understand that my son/daughter is not required to attend this field trip. I give permission for participation in the activity. I agree to release the Santa Rosa County School Board and its officials, officers, and employees from liability for any and all claims of injury which might occur while my son/daughter is participating in this field trip activity. Emergency Medical Authorization Should a medical emergency arise while my son/daughter is participating in this activity, I will be notified at the above number in order to approve medical treatment. In the event that I or one of the emergency contacts listed below cannot be reached, I give permission for immediate treatment as required in the judgment of the attending physician. I understand and agree that I will be responsible for the cost of such treatment.

B.

Emergency Contact:_______________________________Phone Number:_______________ Emergency Contact:_______________________________Phone Number:_______________ Name of Insurance Company:____________________________ Group/Policy Number:_______________
I would like to serve as a chaperone for this field trip I have a Volunteer Application 63-10-04 on file (Requires School Board Approval) Please send me a blank Volunteer Application form 63-10-04 I would like to participate in this Field Trip as a visitor only I have a Field Trip Attendance Application form 50-01-02 on file – School Year _____ Please send me a blank Field Trip Attendance Application form 50-01-02

I have read and agree understand the Milton City Singers info sheet and agree to support my choral student. I agree to arrange pick up for my choral student at Bagdad Elementary School on Thursdays at 4:30.
_____________________________________________ _________________________

Signature of Parent/Guardian Date Signed Please note that only the first 60 permission slips received will be let into the group.