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CMS Band 2020-2021 Permission Slip
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* Indicates required question
Student Name (first and last)
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Your answer
Parent/Guardian's Name
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Your answer
Home Phone (xxx) xxx-xxxx (if none, type "none")
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Your answer
Work Phone (xxx) xxx-xxxx (if none, type "none")
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Your answer
Cell Phone (xxx) xxx-xxxx (if none, type "none")
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Your answer
Name of Emergency Contact
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Your answer
Phone Number for Emergency Contact:
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Your answer
Please list any allergies or medical conditions that we need to be aware of. (if none, type "none")
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Your answer
If your child will need to take any medication during the course of a trip please list: (if none, type "none")
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Your answer
Name of Family Physician (if none, type "none")
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Your answer
Phone number for Family Physician (if none, type "none")
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Your answer
By clicking below, I give my child permission to travel on all Creekview band field trips. In the event of an emergency, I hereby authorize the Creekview Middle School sponsors to act on my behalf if emergency contacts are unable to be reached
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I give my permission.
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Parent/Guardian "Signature" Typed:
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Your answer
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