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4th-6th Grade Field Day Permission Slip

The 4th through 6th graders will be having a special field day to kick off the new school year. This will be a special day of hiking to a waterfall, playing games, two chapel messages, and food.

Location: Camp Ladore, Waymart, PA

Date: September 5, 2025

Departure & Return times: Leaving school at 8:25 a.m. and arriving back at school at 2:30 p.m.

Cost: $0

Lunch: Will be provided by the school. (Students may choose a hoagie of their choice, chips, and drinks.

Dress Code: Girls are allowed to wear knee-length shorts, capris, or long pants, a t-shirt and sneakers. Boys are allowed to wear shorts or long pants, a t-shirt and sneakers.

Transportation: Bus and school vans

Chaperones: The trip will be chaperoned by 3 school faculty members.

Emergency Phone numbers: Mrs. Brown 570-470-1544 & Mrs. Hughes 570-418-5112

Student First & Last Name*

Answer required for "Student First & Last Name"

Parent/Guardian First & Last Name*

Answer required for "Parent/Guardian First & Last Name"

Parent/Guardian Phone Number*

Number Required

Emergency Contact Name*

Answer required for "Emergency Contact Name"

Emergency Contact Phone Number*

Number Required

Family physician*

Answer required for "Family physician"

Family physician phone number*

Number Required

Special medical conditions:

Answer required for "Special medical conditions:"

I give my consent as the parent or guardian of the above named student to participate in this event. In doing so, I agree to the following:

In case of a medical emergency, I grant the chaperones the right to authorize medical care, if none of the persons named above can be reached.
I agree to pay the expenses of returning my child home before the end of the event if he or she does not adhere to the established standards of conduct.
The school is not responsible for damage or loss of property personally owned by my child.

Parent/Guardian Signature*

Signature Required

Choice of hoagie: (hoagies will be 6" long)

Answer required for "Choice of hoagie: (hoagies will be 6\" long)"

Italian hoagie (ham/hard salami/provolone cheese/lettuce)

Turkey & American cheese (lettuce)

Please use this space to leave notes for the office if your child doesn't want something on their hoagie. Tomatoes will be an option for them to put on at lunchtime if they want them.

Answer required for "Please use this space to leave notes for the office if your child doesn't want something on their hoagie. Tomatoes will be an option for them to put on at lunchtime if they want them."

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"