Planetarium Visit Parent Permission Form

Trip Information

School Name:

Date of Visit:

Departure Time:

Return Time:

Planetarium Name:

Student Information

Student Name:

Teacher's Name:

Grade:

Parent/Guardian Consent

I give permission for my child to attend the school field trip to the planetarium on the date listed above.

Emergency Contact Name:

Emergency Phone:

Allergies/Medical Conditions:

Parent/Guardian Name:

Signature:

Date: