Field Trip Permission Slip
All proceeds benefit HS/MS FACT!
Who: Any HS or MS student
Cost: $15.00 Cash or Check (made payable to Summit Academy North HS/MS FACT)
What: Debuck's Corn Maze & Pumpkin Patch 734-260-0334
When: Friday, October 12th (THIS IS A HALF DAY OF SCHOOL.
THE TRIP WILL TAKE PLACE AFTER THE SCHOOL DAY.)
Where: 50240 Martz Rd., Belleville, MI 48111
Time: 1:30 PM depart high school to 4:00 PM arrive back at high school.
Please pick your students up promptly at 4:00 PM!
(ALL STUDENTS MUST WAIT IN THE HIGH SCHOOL CAFETERIA IMMEDIATELY FOLLOWING DISMISSAL. ANY STUDENT NOT AT THE CAFETERIA RIGHT AFTER SCHOOLWILL FORFEIT THEIR OPPORTUNITY TO PARTICIPATE IN THIS FIELD TRIP AND NO REFUNDS WILL BE GIVEN.)
Additional Information: Students should leave laptops and book bags in their lockers, they will be allowed back into the school to pick up these items after we return from the trip. Students should pack a lunch to eat in the cafeteria while they wait. NO LUNCH WILL BE PROVIDED. * In case of bad weather we will go bowling at Lodge Lanes, 46255 I-94 S. Service Dr.,
Belleville, 48111. *
WE NEED CHAPERONES FOR THIS TRIP, IF YOU ARE AVAILABLE PLEASE CONTACT THE MIDDLE SCHOOL AT 734-955-1712.
PERMISSION SLIPS MUST BE TURNED IN BY OCTOBER 5TH WITH PAYMENT.
NO REFUNDS will be issued after turn in date unless the trip is cancelled.
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__________________________________________________ has my permission to attend the field trip. My student and I understand all of the rules and details for this field trip. All school rules apply. A student who does not follow the school rules may be sent home at the parent's expense. Students who have been suspended may not attend this field trip.
Student Signature _________________________________ Date _______________
Parent Signature ___________________________________ Date _______________
PLEASE READ AND SIGN THE BACK OF THIS PERMISSION SLIP IN ADDITION TO THIS SIDE!
PERMISSION TO PARTICIPATE IN FIELD TRIP CONSENT FOR EMERGENCY MEDICAL CARE
I,____________________________________________ , am the parent/guardian
of____________________________________________________ , a student at
. I hereby give my permission for him/her to participate in a field trip to on
__________________________. This permission form has been signed only after
understanding and considering the following: I understand that the student is expected, and has been instructed by me, to do exactly what s/he is instructed to do by the trip supervisors. I understand that the Board of Directors does not, or may
not, carry any insurance relative to this trip or for injuries to the student. I represent that the student has insurance through my own insurance carrier. I request that the above-named student be allowed to participate in the trip planned and specifically consent to his/her participation. If any emergency medical procedures or treatments are required during the trip, I consent to the trip supervisor(s) taking, arranging for or consenting to the procedures or treatment in his, her or their discretion. I release and waive, and further agree to indemnify, hold harmless or reimburse the School, its Board of Directors, the individual members, agents, employees and representatives thereof, as well as trip supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the student, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the student's participation in the trip or the rendering of emergency medical procedures or treatment, if any.
Parent/Guardian___________________________________________________
Address:_________________________________________________________
Telephone: _______________________________________________________
Date: ___________________________________________________________
