Saint Amelia School

Saint Amelia School

2999 Eggert Road
Tonawanda, New York 14150-7199
Phone (716) 836-2230 Fax (716) 832-9700

FIELD TRIP PERMISSION FORM

TEACHER(S):

______________________________________________ Gr. _______ Rm. _______

CHAPERONES:

1. _____________________________ 5. _______________________________

2. _____________________________ 6. _______________________________

3. _____________________________ 7. _______________________________

4. _____________________________ 8. _______________________________

Description of Trip:

Place to be visited: ________________________________________________________

Date of Trip: ____________________________ Cost of Trip: _______________________

Time of Departure: ____________________ Time of Return: _______________________

Lunch: __________________________________________ Cafeteria: Yes ____ No ____

Objectives of Trip:

_______________________________________________________________________

Materials to be brought on Trip:

_______________________________________________________________________

Dress for Trip:___________________________________________________________

Transportation: Bus _______ Other: _________________________________________

Instructions to be given to students by teacher and parent:

_______________________________________________________________________

(In the event that a student is found guilty of any illegal and/or criminal activity, parents will be called to pick them up.)

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Please complete and return this part only.

ST. AMELIA SCHOOL

FIELD TRIP PERMISSION SLIP

I give my permission for ___________________________________________________

to go to_________________________________________________________________

on ________________________, from __________________ to ___________________

I am enclosing $ __________________________ to pay for the cost of the trip.

I have reviewed the instructions given above and assume all responsibility entailed therein.

_______________________________________________________________________
Date / Signature of Parent/Guardian