Senior Class Trip Permission Slip, 2023
FIELD TRIP PARENT/GUARDIAN AUTHORIZATION FORM

It is understood that the Senior field trip to Block Island, Rhode Island; conducted by the Class of 2023 (including advisors, Sarah Armstrong and Jennifer McGrail); on May 31st, 2023, is a yearly tradition amongst the graduating class and is a school sponsored event. Students are expected to conduct themselves in a manner which will bring credit upon them as well as the school. It should be further noted that school rules and handbook policies will remain in effect, as the class travels to Block Island. The group plans to leave at 8:30 AM and return to the high school about 10:00 PM. 

*Bags and personal items will be checked prior to departure via School Administration personnel.
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Email *
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Student Last Name *
Student First Name *
Student Date of Birth *
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Address *
Parent/Guardian Name *
In case of emergency please call: 1st (name & phone number)

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In case of emergency please call: 2nd (name & phone number)

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History of: *
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If your student has allergies please list:
If your student uses an EPI pen can they self- administer?
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If your student uses an Inhaler can they self- administer?
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If student requires medical needs/treatments on Field Trip, please list: none
If student requires medication beyond the school day please list: none
Health Insurance Provider *
Policy Number *
Preferred local hospital umass  *
Doctor's Name, Address, and Phone Number
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I herby give permission for my child/student to attend the field trip designated above, for the duration specified, by the regular transportation facilities provided by the school for the trip.  

I herby give permission for my child/student to be transported and to participate in all activities on the field trip and I give permission for school personnel to transport my child to a medical facility and to secure emergency medical treatment for my child/student, if necessary.  
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