CAM Academy Activity Permission Form
Frenchman’s Bar Color War Reward Day, June 13, 2014
Student:____________________________________ Grade:____ Teacher:___________________
My student, as listed above, has my permission
to participate in the activity described below.
__________________________ X____________________________
Parent
Printed Name Parent
Signature
On the day of the activity I can be reached at:____________________________
or ____________________________
An alternate emergency contact person
is:_____________________________________ at _____________________
Insurance
Name: __________________________________ID#_____________________________________________
Medical
concern(s): ____________ ____________________________________________________________________
My
student may need to take the following medication while at the activity: _____________________________________
The
authorization documentation has been submitted to the school nurse and the
medication is located:
{ } in the health room or
{ } my student has
authorization to carry their medication with them.
{
} I would like to be a chaperone for this event.
I
have submitted a volunteer form within the last two years and am cleared to
chaperone.
(If you are not sure,
please call Student Services at 885-6827 for verification)
Number
of Chaperones needed: (state details of chaperone
needs here – make note if they need to pay fee or not)
If the
required number of chaperones is not met, this event will be cancelled.
EVENT DETAILS
This space for teacher to list details of the event. Please be sure to include the following:
ACTIVITY: Color War Reward Day
DATE
& TIME: June 13th from 10 A.M. -1:30 PM
LOCATION:
Frenchman’s Bar
COST:
$3 parking fee
Permission form must be turned to participate!
**Please be sure your
student is picked up on time after the event.
Students who are not picked up on time will not be able to attend the
next school activity without their parent being in attendance.
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