Merit Trip Permission Slip

Location: Knoebels Amusement Park

Date: May 16, 2024

Departure & Return times: Leaving school at 8:30 a.m. and arriving back at school at 7:30 p.m.

Cost: $29 per student (tickets MUST be purchased by the school no later than April 28th in order to keep this price)

Need: Bring a bagged lunch OR buy a lunch offered by the school. $5 for a hoagie, chips, and bottled water.

Dress Code: Girls are allowed to wear knee-length shorts, capris, or long pants and a t-shirt (not white) and sneakers. Girls that wear shorts need to bring either a pair of capris or long pants to change into if their shorts are not long enough. Guys are allowed to wear shorts or long pants and a t-shirt (not white) and sneakers.

Transportation: Bus and school vans

Chaperones: The trip will be chaperoned by 9 school faculty & staff members.

Emergency Phone numbers: Mr. Boole (724-840-8423) or Mrs. Swingle (570-470-7675)

Student First & Last Name*

Answer Required

Parent/Guardian First & Last Name*

Answer Required

Parent e-mail address*

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

I would like to purchase the following: (Send in check by May 13th OR fill out credit card information below)*

Answer Required

Italian Hoagie ($5)

Turkey & cheese hoagie ($5)

Knoebels pass ($29)

No lunch

No pass

Payment by credit or debit card

Answer Required

$5.00 - One lunch only

$10.00 - Two lunches only

$34.00 - Knoebels pass and one lunch

$39.00 - Knoebels pass and two lunches

$29.00 - Knoebels pass only

Notes for office:

Answer Required

Please fix the highlighted areas below before submitting.

Merit Trip Permission Slip