Elementary Field Trip Permission Form • Boston Science Museum

Boston Science Museum

ELEMENTARY PERMISSION FORM
Date:

May 14, 2024

Destination:

Boston Science Museum
1 Science Park
Boston MA

Schedule:

Leave Windham Woods at 8:30am
Snack on vans (students pack snack and lunch)
10:30-11 - Planetarium Show: Explore the Solar System
11:30-12 - Bag Lunch
12-1:15 - Tour Museum Exhibits
1:15-1:30 - Depart for WWS to arrive before dismissal

Transportation:

WWS Transportation

Cost and Online Payment:

$25 (Pay at the bottom of this form)

Academic Rationale

This trip is a way for students to experience hands-on science that relates to several of this year's WWS Science units, including Scientists & the Scientific Method, the Water Cycle, and Space & Our Solar System. We are especially excited to have tickets for all students to see the Solar System Planetarium show which revisits our very first unit of the year. In small groups, students will also have the opportunity to explore the Science Museum exhibits based on individualized science interests.

Please indicate your interest in chaperoning this field trip on the form below. We are looking for about six parents who would like to join us. Thank you!
STUDENT'S NAME*

First NameLast Name
PARENT/GUARDIAN NAME*

First NameLast Name
PARENT/GUARDIAN PHONE NUMBER*
EMERGENCY CONTACT 1*

First NameLast Name
PHONE NUMBER OF EMERGENCY CONTACT 1*
EMERGENCY CONTACT 2

First NameLast Name
PHONE NUMBER OF EMERGENCY CONTACT 2
CHAPERONES *Thank you everyone who has already volunteered! We have received more than 6 requests to chaperone, so we are no longer asking for volunteers. Please indicate below if you would like to be put on a list of backup chaperones in case a need arises.*

I would like to be put on a list of back-up chaperones for this field trip.I am unable to chaperone this trip.
STUDENT TRANSPORT INTO BOSTON*

My child will be at school by 8:30am and ride WWS transportation into Boston.I will transport my child into Boston and meet the group at the museum.
STUDENT TRANSPORT BACK TO WWS*

My child will ride WWS transportation back to WWS in time for dismissal.I will pick up my child by 1:15 at the Boston Science Museum and bring them home myself.
UPDATED HEALTH INFORMATION

THE INFORMATION BELOW MUST BE COMPLETED PRIOR TO EACH OFF CAMPUS TRIP
My child has:*

No health concernsThe following health concerns/issues:
Date of most recent tetanus shot date
List any physical limitations or medical equipment required for physical activities. Write "none" if there are none.*
ALLERGIES - If your child has allergies please click on "other" and list allergen, reactions, and treatment plan.*

NoneYes (please list allergen, reactions, and treatment plan)
EPIPEN*

YesNoOther
List all medication your child takes and the reason below:
My child needs to take medication while on this field trip.*

YesNo
If your child needs to take medication while on this field trip, please contact the school nurse to complete the appropriate paperwork required for administration of prescribed medications.
Agreement and Signature
By signing below, I give permission for my child listed above to attend this field trip. I give permission for a Windham Woods Staff Member or hired bus driver to transport my child via van or bus to and from the trip destination.

The health history provided on this document is correct and complete. In the event of an emergency or serious illness, I request that you contact me.

If I cannot be reached in an emergency, or if school personnel deem it necessary, I give my permission for first aid and/or emergency medical care, including activation of the emergency medical system. I recognize my responsibility, through appropriate insurance or otherwise, to cover medical and transportation expenses resulting from illness or injury during this program.
PARENT/GUARDIAN SIGNATURE*

Powered by Jotform SignClear
PARENT/GUARDIAN NAME

First NameLast Name
Date

MonthDayYear
Date

My Products

Boston Science Museum

$25.00 Quantity
Item subtotal:$0.00

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Boston Science Museum

Date:

Schedule:

UPDATED HEALTH INFORMATION

Agreement and Signature