Field Trip to Indianapolis

Field Trip to Indianapolis
Monday, May 23, 2022

A charter bus will transport students and staff.
Student Name

First NameLast Name
Student's Homeroom Teacher
Parent Name

First NameLast Name
Parent Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (Other than Parent)

First NameLast Name
Emergency Contact Phone Number (other than Parent)
Please enter a valid phone number.Format: (000) 000-0000.
Yes
Yes
Yes
YesNo
If you would like to attend as a chaperone, please complete a background check form. The cost for parents riding the bus is $50, and parents are responsible for their own lunch. Checks payable to Cedar Crest Intermediate PTO.
As the parent/guardian of the above named student, I give my permission for him/her to participate in the field trip to Indianapolis. I understand that every reasonable precaution will be taken to safeguard my child during, and in transporting my child to and from each activity. I agree to release and hold harmless the Southeast Dubois County School Corporation, bus drivers, and school employees from liability and any injury cased by the child's own actions or from actions not foreseeable or beyond the school's control while attending/participating in the field trip.

Clear
Date

MonthDayYear
Date
Parent Signing

First NameLast Name
Should be Empty:

Monday, May 23, 2022