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FIELD.TRIP FORM

Student's name Yrn+i itntt

Grade lo

Destination ″ι
月‖
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Ч Te(?

ParenUGuardian r4E@LiilA AErt rl

Phone number oglz tefig-|s.€
Emergency contact 031ク ヤ,7 TtZ (floltrs
′ P1

By submitting this form, you are confirniring your child's participation in the field trip

and your commitment to make the necessary payment as per the due date mentioned

in the letter.

As part of our commitment to ensuring the siafety and well-being of all our students during the

upcoming field trip, we kindly request your cooperation in providing relevant medical
information about your child. lf your child has any chronic medical conditions, allergies, or

requires medication administration during ther trip, please fill out the following form and return

it to us at your earliest convenience.

top nor^l tr Ha I no fiLLe L€iy;t oL l'tHf L CHRortic iLt x[trLJ

*For Malang and Thailand field

trip fees are subiect to change due to fluctuations in air
ticket prices.

Ylt{raLinA Apniryl /.u6 ot th , 2ol|

ParenUguardian signature Date

Please return this form to homeroom teacher by the 4th or

CTVINC . COMPASSION . SELF-CONTROL I