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Field Trip Permission Slip
The following permission slip form is good for all field trips for the 2020/2021 school year.
If Achieve staff will be driving your child you must fill out every field!
*
Indicates required field
Student Name
*
First
Last
Parent/Guardian Phone Number 1
*
Parent/Guardian Phone Number 2
*
Doctor's Name
*
First
Last
Doctor's Phone Number
*
Hospital Preferred
*
Name of Insurance Company
*
Policy Number
*
My child takes the following medications:
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By typing my name below, I certify that I am the parent or guardian of the above named student now attending Achieve Learning Center. The above mentioned school has my full permission to allow my child to attend a field trip traveling with an Achieve Staff Member on the streets and public highways. I agree to hold harmless and release from liability Achieve Learning Center or any employee or representative therof, for any action, claim, or damage that may arise as a result of my child's participation.
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First
Last
[object Object]
By typing my name below, I agree to the following: In the event my child needs emergency or medical treatment, every attempt will be made to contact us, the parent/guardian. In the event I/we cannot be contacted, I/we give our permission to Achieve Learning Center to secure prompt treatment for my child.
*
First
Last
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