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Cross Country Permission slip

Location: Village Park, Carlisle, PA

Date: April 21, 2026

Departure & Return times: Leaving school at 9:45 a.m. and arriving back at school at 7:30 p.m.

Cost: Money for a meal stop

Dress Code: Wear sweatpants during travel. Wear your Cross Country shirt and school shorts or black shorts that are as long or longer during the meet.

Transportation: School vans

Chaperones: The trip will be chaperoned by Mrs. Christy Robinson and Pastor Rod Schweinsburg

Emergency Phone numbers: Mrs. Christy Robinson 717.475.7739 and Pastor Rod 570.878.2758

Student First & Last Name*

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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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Note for teacher:

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Confirmation Email

Confirmation Email *

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