Precious Blood School

FIELD TRIP PERMISSION

To be attached to form with trip details sent to parents

STUDENT LAST NAME *

STUDENT FIRST NAME *

Parent /Guardian Full Name *

DATE OF TRIP *

LOCATION OF TRIP *

Home Phone *

Cell Phone *

Work Phone with Extension if Applicable *

Name of Person to Notify in Case of Emergency if Parent/Guardian is Unavailable *

Phone Number of Person to Notify if Parent/Guardian is Unavailable *

Health Insurance Company *

Policy Number *

TODAY'S DATE *