WE, THE PARENTS OF _______________________________ ALLOW OUR CHILD TO ATTEND
A FIELDTRIP TO LANARK ON SEPTEMBER 19TH, 2011 OR SEPTEMBER 29TH, 2011 OR
OCTOBER 3, 2011 IN THE EVENT OF AN ACCIDENT, WE DO
NOT HOLD PRATTVILLE HIGH SCHOOL, THE FACULTY / SPONSORS / DRIVERS, OR AUTAUGA
COUNTY BOARD OF EDUCATION LIABLE. WE AGREE TO PROVIDE A MEDICAL HISTORY
INCLUDING OUR CHILDS’S DOCTOR’S NAME AND A COPY OF AN INSURANCE CARD. THE
BUS WILL LEAVE AT 7:30 A.M. THE DAY OF THE TRIP. IN THE EVENT THAT MY CHILD
IS LEFT BEHIND, I UNDERSTAND THAT MY CHILD CAN NOT DRIVE TO LANARK.
WE, THE PARENTS OF _______________________________ ALLOW OUR CHILD TO ATTEND
A FIELDTRIP TO MCWANE ON NOVEMBER 7, 2011 OR NOVEMBER 8, 2011 OR NOVEMBER 9,
2011 IN THE EVENT OF AN ACCIDENT, WE DO NOT HOLD PRATTVILLE HIGH SCHOOL, THE
FACULTY / SPONSORS / DRIVERS, OR AUTAUGA COUNTY BOARD OF EDUCATION LIABLE. WE
AGREE TO PROVIDE A MEDICAL HISTORY INCLUDING OUR CHILDS’S DOCTOR’S NAME AND A
COPY OF AN INSURANCE CARD. THE BUS WILL LEAVE AT 7:30 A.M. THE DAY OF THE
TRIP. IN THE EVENT THAT MY CHILD IS LEFT BEHIND, I UNDERSTAND THAT MY CHILD
CAN NOT DRIVE TO OR MCWANE OR UAB.
_____________________ OR _________________
MOTHER FATHER
LIST OF ANY MEDICAL PROBLEMS:
1.
2.
PLEASE LIST TWO EMERGENCY NUMBER WHERE YOU CAN BE REACHED
NAME TELEPHONE NUMBER
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***ANY EXTRA MONEY LEFT IN THE ACCOUNT WILL BE USED TO PURCHASE HANDS ON
ACTIVITIES ****
