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5th-6th grade permission slip

The 5th and 6th graders have a field trip planned as follows:

Location: Electric City Trolley Museum and Ride

Date: October 5, 2023

Departure & Return times: Leaving school at 9:00 a.m. and arriving back at school at 2:30 p.m.

Cost: $10 for students and parents. The $10 cost for the trip is to be paid by cash or check made payable to Debbie Hughes. There is a gift shop if you want to send money with your student for that.

Lunch: Students should bring a bagged lunch (lunchboxes with ice packs or thermos type foods are fine)

Dress Code: Boys & girls - long pants/jeans, casual shirt/sweatshirt, and sneakers

Transportation: Bus

Chaperones: The trip will be chaperoned by the 5th & 6th grade teachers

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

Trip agenda: Tour museum/gift shop 9:45-10:45; Lunch 11:00-11:30; Trolley ride - noon-1:15

Student First & Last Name*

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Parent/Guardian First & Last Name*

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Parent/Guardian Phone Number*

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Emergency Contact Name*

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Emergency Contact Phone Number*

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Family physician*

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Family physician phone number*

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Special medical conditions:

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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*

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Confirmation Email

Confirmation Email *

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