Field Trip Permission Slip Form

FIELD TRIP PERMISSION SLIP FORM JOLIET DIOCESAN SCHOOL SYSTEM St. Pius X Parish School

October 28, 2015

On Friday, November 6, 2015, our seventh grade students will be taking a field trip to the Field Museum in Chicago, Illinois. The educational benefit of the trip will be to give the students an opportunity to see all the displays at the museum.

We will leave school at 8:45 a.m. and arrive back to school by approximately 2:00 p.m.

Students will need to wear their St. Pius X school uniforms as they are representing our school today along with gym shoes only.

Students will need to bring a sack lunch and a disposable drink as we will be eating lunch at the museum.

The cost for this field trip is $7.00 per child. Payment should be made by check only, payable to St. Pius X Parish School. There is no refund for field trips. The hot lunch calendar is marked, please do not order hot lunch for this day as we are unable to refund.

Please return the signed permission slip no later than November 5, 2015. with payment. Verbal permission will not be accepted. We will be unable to accept handwritten permission slips. Per the Diocese of Joliet only this form will be allowed to permit the child to attend.

Thank you,

Ms. Sara Voelker Mrs. Mary Koykar

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I request that St. Pius X Parish School take my child ______on a field trip to the Field Museum.

I hereby release and indemnify St. Pius X Parish, Lombard, Illinois, its staff, volunteers and the Joliet Diocese, from any and all liability arising from claims of any kind or nature whatsoever from my child’s participation in this event.

RELEASE: If emergency treatment is required, and the parents or legal guardian cannot be reached immediately, your signature in the space provided below empowers the school authorities to exercise their judgment to transport the child to a hospital emergency room.

Signature of Parent or Guardian______

Date______

Address______

Phone number where I can be reached during the event:______

I am available to chaperone for this event______

All chaperones must have taken Protecting God’s Children and submitted copy of their certificate to the school office, a background check, a DCFS form, and a Pastoral Acknowledgement to the school office.