Number the Stars 7th Grade Field Trip

Senior Ski Trip Deposit and Info!

Saturday, February 15 - Monday, February 17

Lead Chaperones: Ms. McCants, Mr. Singleton, and Ms. Sullivan

Cost of trip: $380.00 (a deposit of $80.00 is required to reserve your spot). If you have not paid the deposit-than you are not able to attend this field trip.

Cost Includes: Transportation, Lodging, Skiiing at Appalachian Mountain Ski, Ski Equipment Rental, Tubing, and Six Meals.

*We will be staying in or around Boone, North Carolina, and, depending on the number attending, renting cabins rather than staying in a hotel.

This form can be used to make all the separate payments for this trip.

Ski 2nd Payment $100.00 due October 1st

Ski 3rd Payment $100.00 due December 1st

Ski Final Payment $100.00 due February 1st

Any questions regarding this trip can be sent to melissa.mccants@psaschool.org
Paid?
Student's Name: *

First Name Last Name
Parent / Guardian's Name: *

First Name Last Name
Parent / Guardian's Contact Number: *

Area Code Phone Number
Parent / Guardian's Email Address *
The following special health problems concerning my child should be noted. If none, please check "none". *

Heart Condition Allergy Asthma Hemophilia Diabetes None
Please describe the condition noted above with particularity, including any medications or other instructions:
i.e. What are they allergic to? What medications will they need access to or bring on the trip?, etc.
Student's Physician: *
Physician's Phone Number: *

Area Code Phone Number
Alternative Emergency Contact Name: *

First Name Last Name
Alternative Emergency Contact Phone Number *

Area Code Phone Number
Alternative Emergency Contact Relationship to Student: *
Please indicate below by clicking the box and signing that you agree to the following:
By digitally signing below, I acknowledge that I have read the information in this form, verifying its accuracy, and agree to the statements made above:
Parent / Guardian Signature: *

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How would you like to pay? *

Cash/Check Credit Card

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Please complete your debit or credit card payment below.

Ski Trip Deposit $ 80.00

Ski 2nd Payment $ 100.00

Ski 3rd Payment $ 100.00

Ski Final Payment $ 100.00

All (minus the deposit) Payment Option $ 300.00

Total $ 0.00

Credit Card
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Credit Card Number	Security Code
Expiration Date	Postal Code

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