Howard County Schools PERMISSION SLIP FOR FIELD TRIP ‘Mount View Middle School Destination: Marriotts Ridge High School ‘Teacher-in-Charge: Samantha Grimes Departure Date: 12/7/2021 ‘Return Date: 12/7/2021 Time: 5:00pm Mode of Transportation: Walking Bus Company: N/A This trip will be [Astudent Day RExtendedDay overnight CINon School Day Alternate plans in case of postponement or cancellation: N/A Additional information: Students may bring @ snack and they willbe picked up at MVM. Class/Group: _7#/8**grade Symphonic Band/Chamber Choir Total f of students: 88 Objective of trip: To recorda performance collaboration for the winter concert. Anticipated Ratio of Chaperones to Students: 1:15, Meal Arrangements: N/A Appropriate Attire: Concert attire Admission Cost $0.00 Please complete portion below dotted line and return to school with any payment indicated above by 11/29/2021 There may bea separate attachment detalling the itinerary, special clothing or cash requirements, as well as any additional rules or procedures, Please contact Teacher in Charge as soon as possible if you have any special needs regarding the trip. PLEASE READ REVERSE SIDE FOR ADDITIONAL INFORMATION Name of Student: (please print) Date of Birth Name of Parent/Guardian (please print) Physical Address of Parent/Guardian Contact numbers for Parent/Guardian (h) Alternate emergency contact name: _ Alternate emergency contact phone ts (h) Health Insurance company and policy/group information: _ | grant permission for (print student name} to goto (destination), con (date)___ Irecognize that the Howard County Public School System cannat be held responsible for conditions beyond their control. Parent Signature _. Date ___|2m avallable to chaperone and accept the duties and responsibilities ofthe position, Chaperone Name: Chaperone Signature: Chaperone Phone: _— Chaperone Emall Parent/Guardian Name (Print) Parent/Guardian Signature __ Date,