Newbury Park High School "Senior Picnic and Grad Nite" Field Trip/Excursion & Medical Treatment Authorization
NPHS Senior Picnic and Grad Nite are for NPHS Seniors ONLY.

NOTE: In order to purchase tickets for the Senior Picnic and/or Grad Nite, an NPHS senior MUST complete a permission form before ticket sales begin in March.

Method of Transportation (All students must take the same method of transportation): SCHOOL ORGANIZED BUS.

Senior Picnic Location: Surprise Location    DATE & Time: Thursday, 5/26/22 10am-4:30pm  

Grad Nite Location: Six Flags Magic Mountain            DATE & Time: Friday, 6/9/23-Saturday, 6/10/22 6pm-5am

Supervision: Administrative Staff & Certificated Teachers

Please complete the following questions to attend your Senior Activities.
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Email *
Student ID # *
Student Last Name *
Student First Name *
Student Date of Birth *
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Student Home Address *
I hereby give permission for my child or ward (named above) to participate in the Senior Activities Field Trips. *
Regarding special assistance/accommodations: Is special assistance/accommodation necessary for your child or ward to participate in these Field Trips? *
If answered yes to the above question, please explain the special assistance/accommodations needed.
Regarding administration of medication: All medications must be prescribed, including over-the-counter medications. Is your child or ward required to take medication during the course of this Field Trip or Excursion? Parent/Guardian must contact the school office to obtain form SFA-5010, “Authorization for Any Medication Taken during School Hours,” form SFA-5030, “Authorization For Medications Taken During School Hours, School Activities and Field Trips” or form SFA-5040, “Extended Field Trip or Excursion Medication Authorization” (which must be signed by a parent/guardian and child or ward’s physician). *
If you have health insurance, please list your Company, Policy Number and Group Number. *
Please list additional emergency contacts, should the parent/guardian be unavailable with their phone numbers. *
Conduct: I fully understand that all participants are to abide by and accept all rules and requirements governing conduct during the Field Trip/Excursion. To the extent permitted by the Education Code, any participant determined to be in violation of behavior standards will be sent home at their own or their parent/guardian’s expense. *
Required
In the event of illness or injury: I hereby consent to whatever transportation, x-ray, examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care from a licensed physician as deemed necessary for the safety and welfare of my child or ward. It is understood that the resulting expenses will be the responsibility of the child or ward’s parent(s)/guardian(s). *
Required
I have carefully read this authorization and fully understand its contents and voluntarily consent to its terms and conditions. *
Required
Please read and acknowledge the following: I, the parent/guardian of the student listed on this form, have discussed the Field Trip Form with my student and understand the policy and procedures. A parent/guardian must acknowledge this even if student is 18 years old. Please list which parent/guardian is acknowledging this (by first and last name) which will act as an electronic signature. *
Parent/Guardian Contact Phone Number *
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