Field Trip Permission Form

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Newark Catholic High School

Field Trip Permission

Parent/Guardian:

     Newark Catholic takes all reasonable steps to provide safe and educational experiences for its students. However, the students must assume personal responsibility for their behavior.  If you feel that your student will not assume this responsibility, please contact the school before completing this form.

STUDENT_________________________________________________GRADE______________________________

EVENT AND LOCATION

___________________________________________________________________________________             

DATE____________________TIME leaving______________ TIME returning _______________

Dress Code: NC uniform_________ Casual(appropriate)______________Dress Attire_______

______________________________________________________________________________________________

Cost to Student  ______________________________Date Due  ________________________

Adult in Charge    _________________________Student/Chaperone RATIO________________

My son/daughter may participate in the activities listed above.       Yes_______NO_______

My son/daughter may travel in school-provided transportation.        Yes_______NO_______

My son/daughter may travel in a student-driven vehicle,                 Yes_______NO_______

containing other students, with adult-driven lead & follow-up cars.

STUDENT and ADULT DRIVERS need to complete this section:

a) I have a valid Ohio Driver's License.                                          Yes_______NO_______

b) My vehicle has a valid Ohio Registration.                                  Yes_______NO_______

c) My vehicle is insured for at least $100,000 per person/              Yes_______NO_______

    $300,000 per occurrence.

d) Student drivers must list any moving traffic violations incurred in the last year in the space given:

     I certify that the information given in this section is true. I understand that I must inform all occupants that wearing a seat belt is required. I will follow all driving directions given by the teacher in charge and will only permit persons assigned to my vehicle by this teacher to ride with me.

     Unless stated otherwise on this form all trips begin and end at Newark Catholic.  Drivers are responsible for transportation to NC parking lot for drop-off and pick-up. At no time will any student be allowed to make a trip until this form has been completed and returned to school. The parent/guardian signature below denotes agreement with all parts of this form.

Student Signature:  _______________________________________Date:  __________________

Parent Signature:  ________________________________________Date: __________________

Please complete Emergency Medical Information reverse side

 revised: 6-99