FILE: JSA-F 1

FIELD TRIP PERMISSION FORM OXFORD CITY BOARD OF EDUCATION Oxford, Alabama

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My child  

, has my permission to go on the trip

sponsored by

School on

Should an injury occur to my child while on the trip, I may be reached at the following telephone

number( s)

 I also give permission to the

school and the sponsors of this trip to seek emergency medical assistance for my child and/or

transport him/her to an emergency treatment facility in the event of any injury. We are covered by

(Name of Insurance Company).

The policy number or contract number is:

I am aware that the school will provide supervision during the trip and that my child will be expected to behave as if he/she were in the regular classroom. I and my child recognize that all school rules apply while on a field trip.

Parent/Legal Guardian/Custodian Signature

Date

SOURCE: Oxford City Board of Education, Oxford, AL ADOPTED: July I, 1999