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Field trip form:  (copy, paste, and print)

Your child’s class will be taking a field trip to:                                    Approximate No. of Chaperones:                       




Mode of Transportation



Day  Date   Time

Leave school Return by Cost


Exact cash or check payable to schoolAdditional Information






(Additional information may include phone number where parents can reach their child in case of an emergency at home, overnight accommodations, anticipated arrival time at the event site, etc.)


Important:  Please keep the top portion of this field trip permission form for your records.

#CUT HERE ---------------------#CUT HERE ---------------------#CUT HERE ---------------------#CUT HERE --------------------#CUT HERE



Please return this portion of the field trip permission form to Mr./Mrs./Ms.                                                                


Please return permission slip to your child’s teacher by                                                                                           



I give my child,                                                                                         in Room                                                          


permission to attend the field trip to                                                                                                                               


on                                                                        from                                                    to                                           .


I enclose $                                  (Exact cash or check payable to school) to cover the cost of the trip.


I give permission for my child to receive emergency medical treatment. In case of emergency, please contact


NamePhone Number











My child has special dietary or medical needs such as:                                                                                                  



My child and I are familiar with the Pittsylvania County School Board Code of Conduct and are in agreement that he/she will abide by all rules and regulations while attending this school function.



Parent’s/Guardian’s Signature                                                                             Date                                              


Parents are welcome and encouraged to participate in field trip activities.

q Parent chaperones may or may not be necessary for this trip.  Please indicate your willingness to assist.       If your assistance is needed, the school will contact you.

            q  Yes, I am available to serve as a chaperone. I can be reached at                                                                     .

MOVIE PERMISSION SLIP(copy, past, and print)

I give permission for my child _____________________________________ to watch the film in 
_________________________________ Date:
Signature of Parent
Please return the signed permission slip.