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1st & 2nd grade permission slip (Crayola)

Location: Crayola Experience

Date: October 16, 2025

Departure & Return times: Leaving school at 8:30 a.m. and arriving back at school at 3:30

Cost: $12.00

Lunch: Bring a bagged lunch OR order your lunch from Crayola below by 10/7

Dress Code: School dress (girls are to wear pants) and the boys do NOT need a collared shirt.

Transportation: Bus

Chaperones: The trip will be chaperoned by Mrs. Jones, Mrs. Brock, Mrs. Boole, and Mrs. Lee

**Parents may attend for the same cost as the student, but parents have to drive themselves or carpool. There is no room on the bus.

Emergency Phone numbers: Mrs. Jones (570) 729-7017 and Mrs. Boole (724) 840-8422

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.

Student admission

Answer required for "Student admission"

Price: $12.00

Adult admission

Answer required for "Adult admission"

Price: $12.00

Quantity

Pizza, chips, and bottled water (order by 10/7)

Price: $6.00

Quantity

Hot dog, chips, and bottled water (order by 10/7)

Price: $6.00

I will pay by cash or check made payable to CCA by 10/7

Answer required for "I will pay by cash or check made payable to CCA by 10/7"

$12.00 student

$6.00 - Pizza, chips, and bottled water

$6.00 - Hot dog, chips, bottled water

Parent/Guardian Signature*

Signature Required

Note for teacher:

Answer required for "Note for teacher:"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"