Day Care In Slidell LA - Childrens Discovery & Learning

Field Trip Permission Form

Please complete this form that will accompany your child on the field trip. This information is necessary should we need to contact you while we are away from the school. No student will be allowed to participate without this form being completed and signed by the parent or guardian. The information on this form is considered confidential and will accompany the school trip leader/nurse on the trip.

Permission is granted for

Child's First Name

Child's Middle Initial

Child's Last Name

Child’s Date of Birth

Event:

Type of Vehicle to be Used: (ex. center, parent's, contract)

Location:

Date of Event:

PARENT/GUARDIAN INFORMATION:

Parent/Guardian First Name

Parent/Guardian Last Name

Address

Address Line 2

City

Zip

Phone Number

Emergency Phone #:

Please provide the information requested below, as it may be needed in case of an emergency. This information does not modify the information on the emergency card.

Allergies:

Conditions requiring special consideration (medical/physical):

Does your student require:

(A) Epipen

Yes

(B) Inhaler

Yes

(C) ANY MEDICATION CURRENTLY TAKEN: (Type of medication and time of administration):

THIS INFORMATION WILL REMAIN CONFIDENTIAL. IT WILL STAY WITH THE SCHOOL TRIP LEADER ON THE DAY OF THE TRIP.

I give my permission for my child to be transported to and from the above activity and to participate in the activities associated with this event

Date

By clicking the above button, I consent to be contacted by Childrens Discovery & Learning and Webit, Inc. at any email address or telephone number I provide, including, without limitation, communications sent via text message to my cell phone or communications sent using an autodialer or prerecorded message. This acknowledgement constitutes my written consent to receive such communications. I agree and consent to any applicable Terms and Conditions of Use or Privacy Policy available on this website.

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