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2023 6th Grade Camp - Permission Form

IMMACULATE CONCEPTION SCHOOL-DARDENNE PERMISSION FORM FOR FIELD TRIP PARTICIPATION

Dear Parent or Legal Guardian:

Your son/daughter is eligible to participate in a school-sponsored activity requiring transportation to a location away from the school grounds. This activity will take place under the guidance and supervision of employees from Immaculate Conception Catholic School. A brief description of the activity follows.

GRADE LEVEL: 6th

DESTINATION: CAMP LAKEWOOD

DESIGNATED SUPERVISORS: MRS. SANBORN, MRS. SCHULTZ MRS. NAEGER

DATE & TIME OF DEPARTURE: Monday, April 24th, 2023 at 7:00 am

DATE & ANTICIPATED TIME OF RETURN: Friday, April 28th, 2023 at approximately 11:30 am.

Arrival updates will be given through ICD’s messaging system. Please do not call the school office for bus updates.

METHOD OF TRANSPORTATION: Buses

STUDENT COST: Cost is included in the total camp cost

If you would like your child to participate in this event, please complete and submit the following statement of consent. As a parent or legal guardian, you remain fully responsible for any legal responsibility, which may result from any personal actions taken by the named student.

I hereby consent to participation by my child in the event described above. I understand that this event will take place away from the school grounds and that my child will be under the supervision of the designated school employee(s) on the stated dates. I further consent to the conditions stated above on participation in this event, including the method of transportation. *

Full Name of Parent Submitting this Form

Answer Required

Date*

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Student Last Name*

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Student First Name*

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Parent Last Name*

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Parent First Name*

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Dad Call Phone

Number Required

Mom Cell Phone

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Home Phone

Number Required

Emergency Contact Name (Other than Parent)*

Please list First and Last Name.

Answer Required

Emergency Contact Relationship with Student*

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Emergency Contact Phone Number *

Number Required

Emergency Contact 2nd Phone Number

Number Required

Confirmation Email

Confirmation Email *

Email Required