WashingtonCounfySchoolDistrict

PARENTAL CONSENTAND PERMISSION

IiOR OUT-OF-SCHOOLACTIVITY

Datc:

Student:

Dear ParenVGuardian:

Yourchildhasbeeninvitedto participate
in a fieldtrip activiry. POrc.de o$ HomeS
on Duringthis trip, it is anticipated
that
(date)
your studentwill participatein the followingactivity(ies):

It is the intentthat this trip will accomplish

the followingeducational
purpose(s):

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Your signaturebelow indicatesyour consentfor your child to participate.It, also,indicates
that
you understandthat if any injury occurs,the schoolwill make reasonableefforts to contactyou. In the
meantime,you give permission,in the eventof injury,thatyour studentmay receiveemergency medical
and/oroperationif, in the opinionof the attendingphysician,suchtreatmentis medically
aid, anesthesia,
necessary.

Signature(Parent/Guardian) Date

Home phone

Work Phone

Emergencyphone

F o r m1 0 1 4