Student Travel Permission Slip
Student Information
Student Name
Grade
Age
Teacher’s Name
Trip Details
Destination
Date
Departure Time
Return Time
Purpose of Trip
Parent/Guardian Information
Parent/Guardian Name
Contact Number
Emergency Contact
Medical Information
List Any Medical Conditions
List Any Allergies
Medications Needed During Trip
Permission
I give permission for my child to attend the above described trip and authorize emergency medical treatment if necessary.
Parent/Guardian Signature
Date