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PreK-K5 field trip permission slip

Location: Lakeland Orchard, Scott Township

Date: October 25, 2024

Departure & Return times: Leaving school at 9:30 a.m. and arriving back at school at 2:15

Cost: $12 per student

Lunch: Bring a bagged lunch

Dress Code: Jeans, or long pants (no leggings), a t-shirt, sneakers, and a jacket.

Transportation: Bus

Chaperones: The trip will be chaperoned by Mrs. Hanna, Mrs. McMahon, and Mrs. Highhouse

Emergency Phone numbers: Mrs. Hanna (570) 878-4006, Mrs. McMahon (347) 569-4793, Mrs. Highhouse (570) 498-0470

Student First & Last Name*

Answer Required

Grade*

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Parent/Guardian First & Last Name*

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Parent/Guardian Phone Number*

Number Required

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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Credit/Debit Card Payment for student

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$12.00

Payment by cash or check

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Student ($12)

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

Note for teacher:

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Confirmation Email

Confirmation Email *

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