Date of Trip: June 3, 2009

Destination: Hershey Park

Cost: $60 (includes transportation and

admission to the park)

Time Leaving EMS: 8:30 am

Time Returning to EMS: 8:00 pm (Students will need to be picked up at EMS at 8:00 pm)

Money and Permission Slips Due By: Friday, May 8, 2009

Please keep this portion for trip information

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Please detach and return this part of the permission form

Name of Student: _________________________________________ Grade ________

Destination: __Hershey Park_________________ Date: __________ Paid: ________

I hereby give my permission for my student to participate in the school-sponsored trip listed above. I understand that if the departure or arrival time is outside the regular bus schedule, I will provide transportation to and/or from school. School sponsored trips are part of the school program and therefore staff and chaperones are responsible for reasonable and prudent supervision of students. Students are held to the same code of conduct for the duration of the trip as if they were in school.

In the event that my student should require emergency medical care at any time that he/she is under the supervision of the Cecil County Public Schools or any of its employees or agents, I give my full permission for emergency medical care to be rendered. I understand that every reasonable attempt will be made to reach me at the telephone numbers listed below, but that no emergency care will be delayed or withheld because of an inability to promptly contact me.

Parent/Guardian’s Daytime Phone Number (the day of the trip): _______________________________

Parent/Guardian’s Cell Phone Number: ________________________________

Other Emergency Contacts:

1. _____________________________________________________________________________________

Name Relationship to Student Phone Number

2. _____________________________________________________________________________________

Name Relationship to Student Phone Number

List any medical concerns, allergies, other pertinent health information or any medications that may be necessary during the trip. (Medications will be administered by the classroom teachers. Appropriate forms must be completed.) ___________________________________________________________________________

________________________________________________________________________________________

If someone other than yourself is picking up your student, please put the name and phone number below.

Name of person: ____________________________________ Phone Number: _______________________

__________________________________________

Parent/Guardian Signature and Date

qI am interested in being a chaperone for the Hershey Park trip. (Chaperone cost is $60)

Name of Chaperone _____________________________________________

Bag Lunch Order Form

Bag lunches are available for all students for field trips. If students do not order a bag lunch, they should plan on bringing money for food.

Student Name ______________________________ Homeroom Teacher ________________

Please check the box for either Menu 1 or Menu 2 below.

Menu 1 q Menu 2 q

Peanut Butter and Jelly Sandwich Luncheon Meat and Cheese Sandwich

Veggie Sticks Individual mayo and mustard packets

Fresh Fruit Veggie Sticks

Teddy Grahams Fresh Fruit

Milk Teddy Grahams

Milk

q Cash attached

Full Price $1.75

Reduced Price $.40

If child is eligible for free meals, no payment is needed.

q Please deduct the price of the bag lunch from my child’s account.

q I will provide lunch for my child.