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5th-6th grade field trip (hike)

Location: Varden Conservation Area

Date: May 15, 2026

Departure & Return times: Hike starts at 1:00 and ends at 2:30

Dress Code: Jeans, t-shirt (not white), sweatshirt or hoodie and comfortable shoes for walking. (no shorts)

Transportation: none

Chaperones: The trip will be chaperoned by Mrs. Hughes, Mrs. Brown, Mr. Griffith

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

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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