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1st & 2nd grade permission slip

The 1st & 2nd graders have a field trip planned as follows:

Location: Rail Riders Stadium, Moosic , Pa

Date: May 22, 2024

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

Cost: $13 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 - Yellow t-shirts and jeans or loose sweatpants are acceptable. No shorts or leggings.

Transportation: Bus

Chaperones: The trip will be chaperoned by Mrs. Jones, Mrs. Boole, and several parents

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

PERMISSION SLIP AND MONEY ARE DUE BY MAY 17TH.

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

Student by credit or debit

Answer Required

Price: $13.00

Adult Chaperone by credit or debit

Answer Required

Price: $13.00

Payment

Answer Required

I prefer to pay by cash or check to the school

$13 student

$13 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 *

Email Required