Parental Approval for Off Campus Learning

During the course of the school year, there will be opportunities to enhance student learning and provide educational experiences at various off-campus locations in the form of field trips. Transportation for these trips will be provided by school or chartered buses. Please complete the Health and Permission form below for our files.

Field Trip Health & Permission Form
I understand that I will only be asked to complete my insurance information on this form. However, field trip fees, if any, will be collected individually for each trip, and my permission is given on this form for my child named below to participate in all fields trips during the school year.

I give my son/daughter (listed below) permission to leave the Eastern Christian School campus for all field trips.

I also give permission to ECSA personnel to transport my child (listed below) to or from a doctor and/or hospital for emergency treatment. I also give permission for school personnel to allow hospital personnel and/or licensed physicians to perform emergency treatment and inject or administer drugs in conjunction with such emergency treatment. I understand that if my child needs emergency treatment, I will be contacted. However, if I cannot be reached, this permission form will allow treatment to be secured as quickly as possible.
Student Type*
- International student
- Domestic student
School*
- High School
- Middle School
- Elementary School
Student Name*
First Last
Parent/Guardian/Host Family Name*
First Last
Parent/Guardian/Host Email*
Home Phone (including area code)*
Alternate Phone- Cell (including area code)*
Emergency Contact (in the event you cannot be reached)*
First Last
Emergency Contact Phone (including area code)*
Insurance Company Name*
If your insurance information changes during the school year, please contact the office manager of the school your child attends. Thank you!
Insurance ID Number
Group Number*
Please indiate any limitations, conditions or allergies that would cause an EMERGENCY situation for your child:
Acknowledgement
- I, as parent/guardian of the student listed above, agree to all terms associated with the Field Trip Heath & Permission Form.
Date*
Parent/Guardian Signature*

Parental Approval for Off Campus Learning

Field Trip Health & Permission Form