TVSD Student Trip Approval Form

Student Name: ___________________________________________________________________  Grade: __________________________________

TVSD Employee responsible for the trip: Mrs. Theresa Falcon

Destination: Blue Mountain Ski Resort

Date of the Trip: 1/9, 1/23, 1/30, 2/6, and 2/13     (make up date includes 2/20)

__________________________________________________________________________________________________________________________________________________________________________

Permission:  I give permission for (Student's Name) ___________________________________________________________________________to participate in this trip(s).  In the event that my child fails to follow all the school rules and regulations during the trip, I understand that he/she will be subject to appropriate disciplinary action.  IN the event of a medical emergency involving my child, and in case a parent/guardian cannot be reached, I give consent to the school personnel in charge during the trip to secure appropriate medical treatment.

Medical Concerns: Does your student have any medical concerns that require the attention of the school nurse and/or the trip chaperone(s)?

Yes _____  No _______

Parent/guardian contact number during the time of the trip:  Mobile#________________________________________ Home#___________________________________________

Other Emergency Contact Information: _____________________________________________________________________________________________________________________________

Parent/Guardian Name (Print)________________________________________________________________________________________________________________________________________

Parent/Guardian Signature: ______________________________________________________________________________________________Date:______________________________________

I, a student in the Twin Valley School District, agree to follow all school rules and regulations during this trip.  I understand that failure to do so will result in appropriate disciplinary action.

Student Signature:________________________________________________________________________________________________________Date:_______________________________________