Rev.

7/2009
75.120

STUDENT PERMIT FOR FIELD TRIP

A field trip is being planned to: Victory Theatre Evansville, IN
Purpose: Philharmonic Youth Concert
Date: Thursday March 16, 2017 Hours: 8:30-10:30am Expense: $1.00
4t
Teacher in charge: h and 5th grade homeroom teachers and Mr. Luegers and Mrs. Carwile
Transportation: Bus

Child’s Name: _____________________________________________________________________________
My child has the following medical concerns: ____________________________________________________
_________________________________________________________________________________________
Medications my child takes during the school day: ________________________________________________
_________________________________________________________________________________________
My child has my permission: _________________________ Phone #: ____________________________
(Parent/Guardian Signature)

Rev. 7/2009
75.120
STUDENT PERMIT FOR FIELD TRIP

A field trip is being planned to: Victory Theatre Evansville, IN
Purpose: Philharmonic Youth Concert
Date: Thursday March 16, 2017 Hours: 8:30-10:30am Expense: $1.00
4t
Teacher in charge: h and 5th grade homeroom teachers and Mr. Luegers and Mrs. Carwile
Transportation: Bus

Child’s Name: _____________________________________________________________________________
My child has the following medical concerns: ____________________________________________________
_________________________________________________________________________________________
Medications my child takes during the school day: ________________________________________________
_________________________________________________________________________________________
My child as my permission: ________________________ Phone #: ____________________________
(Parent/Guardian Signature)