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    Bellefonte Area Schools
    Field Trip Permit
     
    Pupils Name _____________________
    I hereby grant permission for my child named above to participate in the field trip to ____________________ on ______________________. I understand that the transportation will be by___________________ and that _____________________ will be in charge. In the event of an accident or medical emergency and I am unavailable for the purpose of providing parental consent, I hereby authorize the physician(s) and staff in the Emergency/Outpatient Department of the appropriate hospital to provide such hospital care that includes routine diagnostic procedures and medical treatment as necessary to my minor son/daughter. I understand that the authorization herein granted does not include MAJOR surgical procedures.
     
    Date ____________
     
    Signature of parent/ guardian _______________________
     
    Phone number where I can be reached in case of emergency ___________________.
     
    Please list any health problems that may need attention during the trip. ____________________________________________________.