River Dell Regional School District

RIVER DELL REGIONAL SCHOOL DISTRICT DAY FIELD TRIP

PARENT CONSENT FORM Teacher(s) Mrs. Bogan, Mr. Clapp______Date _May 17, 2017__ Dear Parents/Guardians: A group field trip has been scheduled as follows: Group or Class __Seventh Grade Class______Day and Date ___Monday June 5___ Destination _____ Meadowlands Environmental Center______Address ___ 3 Dekorte Park Plaza - Lyndhurst, NJ 07071______We Will Leave School at 8:15_ AM, and will return at _2:40_ PM Objective for Field Trip _Wetland ecological scientific field research______Mode of Transportation __Bus______The Cost Per student is $ _26.75___ Which Will Cover _Program fee and bus _____ Your Child Needs to Bring _ Dress appropriately for the weather, check the weather report for the day. The trip will run rain or shine, and outdoor field research will be conducted. Please bring sunscreen. There are NO food services, bring a lunch and drink._ ___ THE FORM BELOW MUST BE COMPLETED WITH INSURANCE NUMBER OR WE CANNOT TREAT YOUR CHILD IN THE EVENT OF AN EMERGENCY EMERGENCY AND HEALTH INFORMATION Emergency Contact: Name ______Phone ( ) ______Home Telephone ( ) ______Health Insurance Name/Number (please indicate if not insured)

Please List Below Any Special Conditions or Health Information School Chaperones Should be Aware of: Conditions ______Special Diets ______Allergies ______Medications ______I Allow My Child To Take This Medication on His/Her Own. PLEASE NOTE: All Medications Must Be in the Original Container Listing Prescription Number and Directions.

To protect your child, school policy requires any child with a medical condition to be seated on the bus with the nurse. If a child has a food allergy and is attending a restaurant, he/she will be seated at a table with other children with food allergies.

IN ORDER FOR YOUR CHILD TO GO ON THE TRIP, YOU MUST COMPLETE THIS FORM AND RETURN IT TO THE SCHOOL. (Date: Friday, May 19, 2017.__) Yes, ______Has My Permission to go on the Field Trip to ______On (Date) ______

Parent/Guardian Signature ______