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5th & 6th grade permission slip

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

Location: Grey Towers, Milford, Pa

Date: May 14, 2024

Departure & Return times: Leaving school at 8:45 a.m. and arriving back at school at 2:30 p.m.

Cost: $2 per person. The cost for the trip is to be paid by cash.

Lunch: Students are to bring a bagged lunch.

Dress Code: Casual - Boys may wear a t-shirt and jeans. Girls may wear a t-shirt and jeans or capris. No shorts or leggings, shirts with no logo other than CCA or its equivalent (Adidas, Nike, etc.) will be approved.

Transportation: Bus

Chaperones: The trip will be chaperoned by Mrs. Hughes and Mrs. Brown

Emergency Phone numbers: Mrs. Hughes (570) 418-5112 and Mrs. Brown (570) 470-1544

PERMISSION SLIP AND MONEY ARE DUE BY MAY 10th.

Student First & Last Name*

Answer Required

Parent/Guardian First & Last Name*

Answer Required

Parent/Guardian Phone Number*

Number Required

Emergency Contact Name*

Answer Required

Emergency Contact Phone Number*

Number Required

Family physician*

Answer Required

Family physician phone number*

Number Required

Special medical conditions:

Answer Required

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

Confirmation Email

Confirmation Email *

Email Required