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Fill out the following form with all appropriate information:
(Fields highlighted with a * are required.)

* Student name (First, Last, Middle initial):,
 
Enter the following information for the trip you are providing permission for:
* Location:
* Date leaving school: at (time)
* Date returning to school: at (time)
 
I understand my child will be traveling by: Bus      Personal vehicle
 
In case of an emergency, please enter contact information:
Note: By submitting this form, you automatically give permission for your child to receive medical treatment.
* Name:
* Phone number:
 
Should we need to contact you regarding submission of this form, please enter contact information:
* Phone number:
 
Sign below (by typing your name) to verify that the above information is correct:
Note: Submitting this form by any person other than the legal parent/guardian of a child could result in school disciplinary and/or legal action against that person.
* Signature:
Date of submission:11/23/2009, 5:14:53 PM
 

Last Updated: 6/22/2009