Editing previous response:

Please fix the highlighted areas below before submitting.

1st & 2nd grade permission slip

1st & 2nd graders field trip

Location: Rail Riders Stadium, Moosic , Pa

Date: May 13, 2026

Departure & Return times: Leaving school at 9:30 a.m. and arriving back at school at 2:45 p.m.

Cost: $15 per person. The cost for the trip is to be paid by cash or check made payable to Canaan Christian Academy, OR there is the option to pay by debit or credit card at the bottom of the form.

Lunch: Students are to bring a bagged lunch. If a parent comes on the trip, you can buy lunch at the stadium.

Dress Code: Casual - Fun Run Shirt and jeans or school pants. No shorts or leggings.

Transportation: Bus

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

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

PERMISSION SLIP AND MONEY ARE DUE BY MAY 8TH.

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:"

Student by credit or debit

Answer required for "Student by credit or debit"

Adult Chaperone by credit or debit (parents must drive themselves)

Answer required for "Adult Chaperone by credit or debit (parents must drive themselves)"

Payment

Answer required for "Payment"

I prefer to pay by cash or check to the school

$15 student

$15 adult

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 *

Answer required for "Confirmation Email"