Form Due by October 3, 2018
We will meet at the entry of the Zoo at 11 am
Fort Worth Zoo Field Trip
Student's Full Name
Date of Trip
Be there no later than 11:10 am!
Select Student's Grade Level
Pre-K - 5th grade
6th grade - 12th
Price of Admission (please send through secure online payment on TSA website, ASAP)
Pre-K - 5th grade ($5)
6th -12th grade ($6.75)
Mode of Transportation
Buses will not be provided
Conditions of Texas Success Academy
I, the parent/guardian/(Adult Student) of the student named above, hereby give permission for my child to take part in the trip described above. I understand that the following conditions apply: a. I understand that my child is expected to behave responsibly and to follow the school’s discipline code and policies. b. I agree and understand that I am responsible for the actions of my child, and I release the school from all claims and liabilities that arise in connection with the trip, except if due to the negligence of school officials. c. I understand that as a parent, if I believe it is necessary to limit my child’s activity to a great extent, then the school may not be able to accommodate my child on this trip and that I and my child will be informed of this decision as soon as possible upon the receipt by the school of this completed consent form. d. I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child. e. I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child. I understand that if my child is found in possession of these substances, he/she will be subject to school disciplinary procedures and possible criminal prosecution. f. I understand that students who violate the school’s discipline code may be excluded in the future by the school from participating in a school trip. This applies to adults students as well.
g. I have indicated below any permanent or temporary medical or other condition(s) including special dietary and medication needs, or the need for visual or auditory aids, which should be known about my child: (please write "N/A" if this does not apply to your child)
Emergency Contact Name:
Phone Number (1)
Phone Number (2)
Phone Number (1)
Phone Number (2)
We are pre-ordering lunches from the Fort Worth Zoo's cafe. (DEADLINE EXPIRED) They are $5/per person. You may bring your own disposable lunch (no glass bottles) labeled with the studen'ts name. If your child has any food allergies, please let us know ASAP so we can inform the zoo's cafe or it may be best for you to pack your child's lunch.
I will provide a disposable lunch for my child on the day of the trip.
I will provide a disposable lunch for myself on the day of the trip.
I will buy lunch for my child from the cafe.
I will buy lunch for myself from the cafe.
Are you interested in joining us as a chaperone? (We are limited to only a few chaperones per trip so we will confirm with you once we receive responses. Also, please note that chaperones will be responsible for paying all trip fees).
Name of Parent/Guardian
Feild Trip Fees (INCLUDE ZOO TICKET AND LUNCH TOTAL)
Credit Card Details
Credit Card Number
Amount Charged (includes credit card fee)
Should be Empty:
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