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Field Trip
Permission Form

This form allows parents and guardians to give permission for their student(s) to attend a school field trip. Field trip details will be provided separately prior to submission of this form.

Please complete all required fields, including student names and grades, emergency contact information, and required acknowledgments. All checkboxes must be selected and the form digitally signed in order for permission to be granted.

Field Trip Permission

By signing below, I am giving permission for my child(ren),

One student per line.

Please include the full name and grade of each student for whom you are granting permission to attend this field trip.

to participate in the field trip to

that will take place on

Media Permission
I give permission for photos to be taken.
I do not give permission for photos to be taken.

Please Note: You must check all of the boxes below for your student to participate in this field trip.

By checking the boxes below, I acknowledge and agree to the following:
Modo de dibujo seleccionado. Para dibujar, necesitas un mouse o un panel táctil. Usa la función de accesibilidad del teclado al seleccionar Escribir o Subir.
Date Signed
Día
Mes
Año

Today's Date

Relationship to student(s)

Emergency Contact Information - Please include a phone number where you can be reached and the contact information for at least one other trusted adult in case of an emergency.

A trusted adult, other than yourself.

Please include any important information we should be aware of for this field trip, such as medical considerations, behavioral supports, or emergency instructions.

USDA Nondiscrimination Statement In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity. Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA's TARGET Center at 202-720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at 800-877-8339. To file a program discrimination complaint, a Complainant should complete Form AD-3027, USDA Program Discrimination Complaint Form, from any USDA office, by calling 866-632-9992 or by writing a letter addressed to USDA. The letter must contain the complainant's name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by: Mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410 or Fax: 833-256-1665 or 202-690-7442 or Email: program.intake@usda.gov This institution is an equal opportunity provider.

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