Permission Slip...Elementary

DIOCESE OF DAVENPORT PARENT/LEGAL GUARDIAN PERMISSION SLIP FOR FIELD TRIP PARTICIPATION

ELEMENTARY
Your son/daughter/legal dependant, is eligible to participate in a school-sponsored or Religious Education Program activity at a location away from the School/Parish site. This acitivity will take place under the guidance and supervision of Burlington Notre Dame Elementary School/Religious Education Program.
Activity Name*
Must fill in name of activity.
Activity Date*

MonthDayYear
Date
Child Name*

First NameLast Name
Please Select Your Child's Grade/Teacher:*
Grade
Teacher's Name
If you would like your child to participate in this event, please complete, sign and return the following statement of consent. As parent, or legal guardian, you remain fully responsible for any legal responsibility that may result from any personal actions taken by the named student.

I hereby request and consent to the participation of my child in the event described above. I understand that this event will take place away from the school/parish grounds. I further consent to the conditions stated above on participation in this event, including the method of transportation.
Printed Name of Parent/Guardian:*

First NameLast Name
Emergency Phone Number*
Please enter a valid phone number.
Email
example@example.com
Parent/Guardian Signature:*

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DIOCESE OF DAVENPORT PARENT/LEGAL GUARDIAN PERMISSION SLIP FOR FIELD TRIP PARTICIPATION