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Diocese of San Diego Field Trip Permission Form Elementary Schools

Dear Parent or Legal Guardian: A field trip is a privilege, not a right. Your son/daughter, guardianship, is eligible to participate in a school-sponsored activity at a location a ay fro! the school site. "his activity ill ta#e place under the guidance and supervision of e!ployees fro! Sacred Heart Parish School. A brief description of the activity follo s: $urriculu! Goal: Social Studies: Communities Destination: USS Midway Designated %upervisor of Activity: Mrs !acarias Date and "i!e of Departure: Tuesday "anuary #$% #&$' (:)& a m Date and Anticipated "i!e of &eturn: Tuesday "anuary #$% #&$' #:'* p m 'ethod of "ransportation: Chaperone +ehicles %tudent $ost: ,- && .ll students must /ring a sac0 lunch All students should ear: S H P S Uniform (f you are re)uesting that your child participate in this event, please co!plete, sign and return the follo ing re)uest for participation. As parent or legal guardian, you re!ain fully responsible for any legal responsibility hich !ay result fro! any personal actions ta#en by the na!ed student. *e hereby release and hold har!less %acred +eart Parish %chool and any and all of its e!ployees fro! any and all liability for any and all har! arising to !y child as a result of this trip. ( re)uest that !y child, _____________________________,a student in grade ___3_____,be allo ed to participate in the event described above. ( understand that this event ill ta#e place a ay fro! the school grounds and that !y child ill be under the supervision of the designated school e!ployee on the stated dates. ( further consent to the conditions stated above for this event, including the !ethod of transportation. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Parent %ignature ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Address ,,,,,,,,,,,,,,,,,,,,,,,,,, Date ,,,,,,,,,,,,,,,,,,,,,,,,,, -!ergency Phone .u!ber

Please return this for! and pay!ent by 1o+em/er $% #&$) /over0 $hildren under the
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eight of 12 lbs. !ust ride in a child safety seat or booster seat.

EME23E1C4 MED5C.6 T2E.TME1T (n the event of an e!ergency, ( hereby give per!ission to transport !y child to a hospital for e!ergency !edical or surgical treat!ent. ( ish to be advised prior to any further treat!ent by the hospital or doctor. (n the event of an e!ergency, if you are unable to reach !e at the above nu!ber, contact: .A'- 5 &-LA"(6.%+(P:_________________________________________________ P+6.-: / 0 _____________________________________________________

7A'(LY D6$"6&:___________________________P+6.-:/ 0______________ ( also authori8e the designated supervisor to ad!inister first aid ith the understanding that Sacred Heart Parish School had docu!entation that the designated supervisor has basic first aid training. ___________________________________ %ignature _________________________ Date

_______________________________________________________________ Address ___________________________________ -!ergency Phone .u!ber

$hildren under the
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eight of 12 lbs. !ust ride in a child safety seat or booster seat.