Division of Athletics, Activities and Accreditation
MIAMI-DADE COUNTY PUBLIC SCHOOLS
PARENT PERMISSION FORM -- FIELD TRIP
Field trips are not mandatory. They are designed to enhance curriculum, to encourage student participation in extra-curricular activities, and
to serve as community service projects.
SECTION I. IDENTIFYING INFORMATION
SCHOOL _________________________________________________________________DATE________________________________
STUDENT'S NAME _________________________________________________________I.D. NO. ___________GRADE/HR_________
SECTION II. NOTIFICATION TO PARENT
__________________________________ is planning a field trip for ___________________________ to __________________________
School Group Sponsor Name Name of School Group Destination
The purpose of the trip is __________________________________________________________________________________________
TRANSPORTATION: Private Vehicle ________ Bus ________ Airline ______________________Other____________________________
Name of Carrier Please Specify
This trip will be chaperoned by ____________________________________________ Cost to each student $ ____________________
(Total Number of Chaperones)
I understand that if I am unable to pay for the cost of this trip, and I want my child to participate, where appropriate, my child will be given an
opportunity to raise funds through authorized fund-raising activities, or be given assistance in identifying another funding source. (This provision does
not apply to activities not directly related to classroom instruction, e.g., Grad Bash, football games, banquets, etc.)
DATE(S) OF TRIP :(Include departure/return time) FROM _____________________________ TO _________________________
--The above time schedule and/or personnel may be changed due to unforeseen circumstances. --
PLEASE KEEP THE TOP PORTION FOR YOUR INFORMATION.
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RETURN THE BOTTOM PORTION TO THE TEACHER.
SECTION III. PARENT/GUARDIAN'S WRITTEN PERMISSION TO PARTICIPATE IN ACTIVITY
I hereby give permission for my child ___________________________________________ Student I.D. No. _______________________
(Child's Name)
to participate in the field trip to______________________________________________________________________________________
(Destination)
DATE(S) OF TRIP :(Include departure/return time) FROM _____________________________ TO _________________________
I have completed the EMERGENCY CONTACT INFORMATION in Section IV (see below).
SIGNATURE OF PARENT/GUARDIAN _____________________________________________ DATE____________________________
SECTION IV. EMERGENCY CONTACT INFORMATION
1. Name of parent/guardian ____________________________________________________
2. Parent/Guardian Phone No(s). Home______________________________ Business ___________________________ Cell________________________________
3. In case parent/guardian cannot be reached, please contact:_____________________________ Relationship __________________Telephone No. _________________
4. Please list any insurance policy covering your child ___________________________________________________ Policy No. __________________________________
5. Physician's Name ______________________________________________________________Telephone No. ______________________________________________
5. Only if applicable, complete the following: a. My child has the following medical problem:_____________________________________________________
FM-4573E Rev. (09-09) b. My child takes the following medications regularly:________________________________________________
(Proper Medical form #2702 is on file at the school)
c. My child has the following allergies: ____________________________________________________________
Clear Form I AUTHORIZE MEDICAL TREATMENT FOR MY CHILD IN CASE OF ACCIDENT OR ILLNESS WHILE ON THE TRIP.
PARENT/GUARDIAN SIGNATURE _______________________________________________________________DATE________________________________________
FM-2431 (Rev. 07-19)
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