Wyoming Area Secondary Center
WAVE Field Trip Permission Form
Name:__________________________________________Date:____________________________
Date of Trip:_11/2/2011______Departure Time: _8:15___Return Time: 2:15_________
Field Trip Coordinator:_Charlene Berti___________Contact Phone# 709-2994_____
Nature of Field Trip: Misericordia workshop__________________________________
Parents: Your son/daughter will be participating in a Field Trip to Dallas PA__________
Place to be visited: Misericordia University____________
And will be traveling by: School Bus
I give permission for my son/daughter to participate in this field trip.
Patent/Guardian's Signature:______________________________Date:__________ __________
PARENTS ~ PLEASE FILL OUT THIS SECTION ~ Important
MEDICAL PERMISION FOR TREATMENT:
Whenever injury or emergency illness occurs to the student listed below while the student is under the supervision of Wyoming Area High School Personnel, every attempt will be made to notify the parent or guardian immediately. However, if the parent or guardian is not available and it is felt that emergency treatment is indicated, the signatures below by the parent/guardian will allow the student to be transferred and treated in a timely fashion. The intention of this form is to grant authority to administer emergency treatment of any and all medical conditions.
____________________________ __________________________ ________________________
Student's Name Parent/Guardian Signature Date
Parent Phone Number:_____________________________________________________________________________
Please supply the following information, if applicable:
Medical conditions:________________________________________________________________________________
_________________________________________________________________________________________________
Medications/Allergies:______________________________________________________________________________
_________________________________________________________________________________________________
Name and Phone Number of person to contact if parent cannot be reached:________________________________
_________________________________________________________________________________________________