PERMISSION SLIP SAMPLE

BELLOWS FREE ACADEMY FIELD TRIP DESCRIPTION

Class: Teacher:

Description of Trip:

Educational Objectives for the trip:

Date(s) of Trip: Alternative date(s) (if any):

Method of Transportation:

Time of Departure: Time of Return:

(Tear off and return this section to teacher)

PERMISSION SLIP

I hereby consent to let my daughter/son

(student's full name)

participate in the activity described. Reasonable caution will be exercised by those in charge. However, neither they nor Bellows Free Academy shall be held responsible or liable in case of injury or accident.

Signature (parent/guardian)