Boyertown Middle School East

                                     2020 Big Road Gilbertsville, PA 19525

6th Grade Field Trip

Tuesday, November 17th, 2026

Reading Royals Hockey Game

Dear Parents and Guardians of 6th grade students,

       On Tuesday, November 17th, 2026, our 6th graders will have the opportunity to take a field trip to watch the Reading Royals play in Santander Center in Reading, PA. During the trip, students will participate in a one-of-a-kind field trip experience, where students will enjoy the excitement of professional hockey while engaging with STEM-aligned educational materials covering math, science, geography, and more!

Expectations:

• Cell phones must be kept out of sight and used only in the event of an emergency. 

• Students should dress appropriately - MSE dress code will be enforced.

• Students who are on the Restricted Access Designation list (RAD) are not allowed to attend field trips.  If you are scheduled to be removed from the RAD prior to the trip, you may sign up.  Note that should you be placed on the RAD prior to the trip and ineligible to attend, you may not receive a refund.  

• Students are expected to be on their best behavior while on the trip and represent themselves, the school, and the District in a positive manner, exhibiting the Bear Essentials of Respect, Responsibility, and Safety.  

• In case of inclement weather, the trip will be cancelled and not rescheduled.

     The cost of the trip is $15. This fee does not include any food, since there are venues to buy food with cash or card at the event. If you need assistance with the payment, please reach out to your child’s homeroom teacher. Please complete the form below and permission slip and return it to school with payment by Thursday, October 8th, 2026. Payment can be made in cash or check made payable to “East Activity Fund” and if paying by check, please put the student’s name in the memo.

.......................................................Tear Off & Return.......................................................

Student Name: _____________________________________________________________________

Homeroomteacher:__________________________________________________________________

Yes, my child will pay $15 to participate in the field trip on Tuesday, November 17th, 2026 and will pack their lunch or buy their lunch at the venue with cash or card

  No, my child will not participate in the field trip.

_______ Yes, my child will need a brown bag lunch provided by the district.

 Parent/Guardian Signature: ____________________________________________________________

BOYERTOWN AREA SCHOOL DISTRICT

FIELD TRIP AUTHORIZATION FORM

(PLEASE COMPLETE ALL SECTIONS OF THIS PAGE)

Child's Full Name___________________________________________________________________Date  Tuesday, November 17th, 2026

Teacher____________________________________________________Cost 

Place Reading Royals Santander Arena Location: Reading, PA

Departure date/time: 8:45 am Return date/time 2:15 pm

*If you wish to allow your child to participate in this trip, please sign the form below, detach it, and return it to the sponsoring teacher by Thursday, October 8th, 2026. If you do not wish to have your child participate, simply do not sign the form. The child will then attend all classes as regularly schedule on the day of the trip. _____________________________________________________________________________________________

AUTHORIZATION

____________________________________has my permission to participate in the educational field to Reading Royals on Tuesday, November 17th, 2026.

I understand that reasonable precautions will be taken to safeguard my child while on the trip.  If my child would need professional medical attention while on this trip, please act on my behalf.  Therefore, I hereby authorize medical treatment for my son/daughter,  _________________________, in case of an emergency and in the event I cannot be contacted.  

MEDICAL HISTORY (PLEASE NOTE “NONE “, IF THIS DOES NOT APPLY TO YOUR CHILD)

**Please list any allergies (food/drug/environmental) or medical conditions of your child.

______________________________________________________________________________________

______________________________________________________________________________________

*MEDICATION: Includes prescribed, over-the-counter, and supplemental medications that are either daily medications, as needed medications (inhalers, allergy related medication,etc.) and/or emergency medications (Benedryl, Epi-pen, etc.). Choose one of the following: 

____________My child WILL NOT need medication during this trip

____________My child WILL need medication during trip hours

          Medication Name_______________________________

 The parent will be responsible for providing all medications required for the trip. The Authorization for School Medication Administration form must be completed and on file in the nurse’s office.

EMERGENCY CONTACT INFORMATION

(MOTHER) HOME(    )_________________WORK (     )____________________CELL(    )___________

(FATHER) HOME(     )_________________WORK(     )____________________CELL(     )___________

PARENT/GUARDIAN SIGNATURE_____________________________DATE_____________________

*Please refer to the student handbook for detailed medication policy.  Authorization Form for Medication Administration can be found at http://www.boyertownasd.org/UserFiles/File/forms/Health/Medication_Request_Form.pdf or contact the school nurse or copy back of permission form.                                                                                                                                   

COMPLETE THIS SIDE ONLY IF STUDENT REQUIRES MEDICATION TO BE ADMINISTERED DURING FIELD TRIP

BOYERTOWN AREA SCHOOL DISTRICT

AUTHORIZATION FOR SCHOOL MEDICATION ADMINISTRATION

Child's Full Name: _________________________________________  Grade/Homeroom: ________________________

Date of Birth: _______________________ Allergies: ______________________________________________________

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PHYSICIAN'S REQUEST

Name of medication (OTC, Prescribed, Vitamins):_______________________________________________________________

Reason: __________________________________________________ Route: __________________________________

Side Effects: _______________________________________________________________________________________ Time and dose(s) to be given at home ___________________________________________________________________ Time and dose(s) to be given at school: __________________________________________________________________

Medication is to be administered:

1._____ until completed.   Date: _______________

2._____ entire school year:   daily _____ prn _____

3._____ other: _____________________________________________________________________________________

___*   I believe this child is able and responsible to carry and self-administer his/her inhaler and/or Epi-Pen during school, on field trips, and at extra-curricular activities upon clearance by their physician, parent and school nurse.  S/he has permission to do so and has been instructed on how to self-administer (Gr. K-12).

___** I believe this child is able and responsible to carry and self-administer the medication on certain field trips and at extra-curricular activities. S/he has permission to do so and has been instructed on how to self-administer (Gr.6-12 only).

_____________________________________________       _________________________________________________

PHYSICIAN'S SIGNATURE                       PRINTED NAME

_____________________                                                       _________________________________________________

DATE           PHONE NUMBER

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PARENT REQUEST

I, the parent/guardian of ______________________________ request that the Boyertown Area School District nurse administer the above named medication as prescribed by my child's physician. My signature on this document constitutes a complete waiver of liability claim in any and all respects against the Boyertown Area School District and its Board of Directors and all employees unless the District is negligent with regard to any claim for injury in connection with administration of the prescribed medication.

Additionally, I agree to hand deliver the medication to the nurse's office in the original pharmacy or physician labeled container. I also accept responsibility to provide a physician's note and my written instructions if the medication is to be changed or discontinued. I give permission for the school and physician to communicate regarding this medication and medical condition.

____*   I believe my child is able and responsible to carry and self-administer his/her inhaler and/or Epi-Pen during school, extra-curricular activities and on field trips.   I give my permission for him/her to do so (Gr. K-12).

____** I believe my child is able and responsible to carry and self-administer his/her medication on certain field trips and at extra-curricular activities. I give my permission for him/her to do so (Gr.6-12).

_______________                     ________________________________________________________________________

DATE                                               PARENT/GUARDIAN SIGNATURE

List all medications currently being taken by this child: __________________________________________________

In accordance with Boyertown’s Medication policy:

*Students in Grades K-12 may carry and self-administer his/her inhaler and/or Epi-Pen during school, on field trips, and at extra-curricular activities upon clearance by their physician, parent and school nurse.  Your initials indicate that the child is capable of proper medication administration.

** Students in Grades: 6-12 ONLY may carry and self-administer his/her medication on certain field trips and at extra-curricular activities upon clearance by their physician, parent and school nurse. Your initials indicate that the child is capable of proper medication administration.

All medication forms must be completed and on file in your child’s school health room before medication can be administered.

______Clearance to carry and self-administer an inhaler and/or Epi-pen has been given by the school nurse

Revised 5/2007