Dear Parent/Guardian:

Your child is eligible for participation in an educational field trip as described below. Please read this information carefully and provide the necessary data. No student will be permitted to participate in the trip unless he/she has first submitted a completed form, signed by both parents/guardian/or a single parent having sole custody of the child.

Student's Name: _____________________________________________________

Student's Home Address: ______________________________________________

City: _________________________ Zip Code: ____________________________

School Attending: Normandy___________ Grade: ___________________________

Date of Field Trip: Thursday April 29, 2004

Field Trip Destination: Green Valley Elementary School Land Lab.

Departing Location: Main Lobbey of Normandy High School

Time of Departure: 8:45 am

Means of Transportation: Walk

Teacher in charge of Trip: Mrs. Sutyak/(Mrs. Goldberg at Green Valley)

In the event that my child should become ill or injured during the course of this educational field trip, I request that you make reasonable attempts to contact me.

In the event reasonable attempts to contact me at home: ( ) ____________or at work: ( ) _____________ Or contact ______________ ___________ at home: ( ) ___________ or work: ( ) ________________

Have been unsuccessful, I hereby give consent for:

1. Administration of any treatment deemed necessary by a licensed physician. And
2. The transfer of my child to a hospital or emergency facility as deemed necessary by school personnel or physician ________________________________

Parent/Guardian Signature: _________________________________

Parent/Guardian Signature: _________________________________

Child/Student Signature: _________________________________

Transportation for this field trip is being provided by the Parma City School District Transportation Department.

Parent/Guardian Signature: _________________________________

Parent/Guardian Signature: _________________________________