MIDVIEW SCHOOL DISTRICT
RELEASE AND ACKNOWLEGEMENT FOR SCHOOL-SPONSORED
FIELD TRIP
The Midview Board of Education has arranged a student trip to:
_______Unverstiy of Akron___________________________ on ____April 9th ____________.
Destination
Date
The Board has provided the opportunities for and permitted the undersigned student to go on, attend,
participate, and/or take part in this activity.
I understand participation in the student trip is not a mandatory function for which my child must
participate and my child’s participation is at my discretion. I understand that in lieu of participation in the
student trip, other educational activities have been scheduled for my child.
I am aware that the school system does not provide specific medical or other health care insurance for the
benefit of my child in case of illness or injury to him/her while participating in the student trip and that
the responsibility of providing insurance is solely mine.
I understand that by signing this form and the participation of my child in the student trip, the student
agrees to abide by all rules and requirements of the school system, its employees and representatives and
that my child’s participation may be discontinued during the trip for violation of the rules and
requirements and he/she may be otherwise disciplined according to the Midview Local School District
policies and procedures.
PLEASE RETURN THE BOTTOM SECTION TO THE TEACHER
The child will need: Number of lunches:
___ child $7.00
____ adult $7.00
___ My child will provide his/her own lunch due to allergies/medical issues
___ No, an adult will NOT be attending with my child
___ Yes, an adult will be attending with my child
Adult Name:________________________________
Please return this permission slip and lunch money by: Friday, March 28th 2014
Based on the above, I hereby give my permission for my child’s participation in said student trip.
____________________________________
STUDENT NAME
_____________________________________
PARENT/GUARDIAN SIGNATURE