-
-
- Trip Date*
- Departure Time
- Return Date*
- Estimated Return Time*
-
-
-
- Date of Birth*
-
-
-
Format: (000) 000-0000.
-
-
-
Format: (000) 000-0000.
-
-
-
-
-
-
-
- I give permission for my student to attend the VOSS field trip*
-
-
- If I cannot be reached in an emergency, I authorize VOSS staff to obtain necessary emergency medical care for my student. I understand that I am responsible for medical expenses not covered by insurance.*
-
-
-
-
Format: (000) 000-0000.
-
-
- Parent/Guardian Signature Date*
-
- Student Signature Date*
- VOSS Staff Receiving Form Date*
-
- Should be Empty: