HARMONY SCHOOL OF SCI ENCE- AUSTI N

11800 Stonehollow Dr. Suite 100, Austin, TX 78758 Tel: 512.821-1700 Fax: 512.821-1702
PARENT APPROVAL FORM
Event Name: Austin Childrens Museum
Date of receiving Permission Paper: Monday, March 2, 2!!"
Due date to turn in Permission Paper: #riday, April , 2!!"
Date of Event: $hursday, April ", 2!!"
#ee: %&!
Dear Parents,
'armony (chool of (cience has arranged a )eldtrip for
rd
grade students* +e are going
to the Austin Childrens Museum* $he )eld trip is scheduled to depart from school on
,-"-2!!" at .:,/am* After the museum tour, 0e 0ill eat lunch at 1il2er Par2* +e are
e3pecting to 4e 4ac2 at school on the same day 4efore 2 pm*
$he )eld trip fee is %&!* (tudents may 4ring e3tra money for shopping*
All students should 4ring a sac2 lunch from home*
+e 2no0 that all of the students are very e3cited a4out this trip*
Contact Phone: .2&5&6!!

Mrs* Chin

$eacher Principal
PARENT-STUDENT APPROVAL FORM FOR ...............
(tudent Name: MA$$'E+ CA7N 8rade-(ection: 9
7, MA$$'E+ CA7N, pledge to a4ide 4y all district policies of the 'armony Elementary (chool District hand4oo2*
7 understand that 7 am governed 4y the same rules on this trip as 0hen 7 am at school* Any failure to adhere to
these policies 0ill result in disciplinary action*
9
:(tudent (ignature; 8rade-(ection:

$his is to certify that MA$$'E+ CA7N has my permission to go on the )eld trip listed 0ith this group*
9y signing this form parent:s; give:s; consent to his-her child to ta2e the transportation provided 4y school or
teacher* Means of transportation could 4e any pu4lic, rental or private vehicles driven 4y an adult*
<<<<<<<<<<<<<<<<<<<<<<<<<<<< ,-=-!"
:Parent (ignature; Date

PERMISSION SLIP/MEDICAL RELEASE FORM
+e :7;, the parent :s;-guardian of MA$$'E+ CA7N understands and agree that the trip is a school sponsored
activity and function* $his release is intended to cover all in>uries of every name, type, 2ind or nature, and
personal property damage, if any, 0hich may 4e sustained or su?ered from any cause connected 0ith or
arising out of, or from participation in the listed events* 7 understand 7 am responsi4le for transportation costs
if my child is re@uired to return home for disciplinary measures* 7 understand 7 0ill 4e given a choice of mode
of transportation to 4e used*
Emergency Medical Release Frm
Name MA$$'E+ CA7N
Parent-8uardian 97AAB CA7N
Address &"!, CEDAC C7D8E DC*, AD($7N, $E 6.6,&
'ome Phone /&2 ,,&5=&"! +or2 Phone 2&"5&=!! Cell Phone ,252.&"
EmergencyContact-Phone FACGDEA7NE CA7N CEAA "&,52.&"
7nsurance Company-Policy-8roup HAE$NA +&==& =/&!
Doctors Name-Num4er +7AA7AM CAAD+EAA
9lood $ype DNINJ+N Ino0n Allergies PEN7C7AA7N
Medication NJNE
Any Additional Medical 7nformation NJNE
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
7n case of emergency, 7 authoriKe emergency treatment to 4e administered if 7 cannot 4e contacted*
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< ,-=-!"
Parent-8uardian (ignature Date
<<< - << - <<<<<
Da!e
Please "#! a c$ec% mar% i& y# d n! 'an! y#r c$ild ! "ar!ici"a!e in !$is &ield !ri"(
S!#den! Name) ************************** +rade/Sec!in) ***********
I d n! 'an! my c$ild ! "ar!ici"a!e in !$is &ield !ri"(
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< <<<<<<<<<<<<<<<<
Parent-8uardian (ignature Date
I& y# le! y#r c$ild ,in #s &r !$e e-en! .y $is/$er sel&/ "lease &ill !$is "a"er
#! and $a-e y#r c$ild ! re!#rn i! ! !$e &rn! &&ice(