Student Name: ___________________________ Pod: _______ Ac Lab Teacher: _______________

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Kyrene School District No. 28

Field Trip Permission Form

April 21, 2014 To the parent/guardians of students in the 8th Grade Class at Akimel A-al Middle School: Akimel A-al Middle School is planning a field trip to Big Surf for an eighth grade activity day. WHERE: Big Surf Waterpark, 1500 N. McClintock Road, Tempe, AZ 85281

DATE: Monday, May 19, 2014 TIME: 9:00 am – (approx.) 5:30 pm

COST: $20.00 per student for admission Payments must be made online at www.kyrene.org/eservices. We do not accept payment at the school.

Bar Code: 28844

Payment for this trip is not tax credit eligible. No financial assistance is available for this trip. Should your child not be able attend for any reason, no refunds are available. Lunch is included in the cost of the trip (Hamburger meal, chips & drink) All eligible 8th grade students will be transported by Kyrene District busses to Big Surf at 9:00 am. Students will not have bus transportation home (this includes busses to Maricopa). Parents must pick up their

student at AMS between 5:00 and 5:30 pm (time is approximate) in front of the school. Students without a completed permission slips will not be able to attend. We are not able to accept verbal

permission. Students who are on Social Probation (for grades or behavior) or have not turned in Library books/textbooks by

May 12, 2014 will not be eligible to attend. Those students will be provided a regular day school at Akimel A-al Middle School.

Students should arrive at school in school-appropriate clothing (swimsuits must be covered). Students may bring the following items: swimsuit, towel, change of clothing, hat, sun block, sunglasses, and money

for snacks, drinks and locker rental. The school is not responsible for lost or stolen items.

I am aware that classroom students are the only students allowed on the trip.

No other students, siblings or guests may accompany volunteers or supervisors.

Please return this signed permission slip/medical consent form no later than Friday, April 25th, to Student Services. No student will be permitted to attend this trip without written permission.

My signature below indicates that I have read the information contained in this document. ______ (initial) I approve of ___________________________ participating in the Big Surf field trip, May 19, 2014. ______ (initial) I do not approve of __________________________ participating in the Big Surf field trip, May 19, 2014 and instead direct that he/she participate in the alternative learning experience.

_____________________________________________ ___________________________________ Signature of Parent/Guardian Date Contact Phone #: _____________________________ Contact Email: _____________________

Student Name: ___________________________ Pod: _______ Ac Lab Teacher: _______________

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MEDICAL RELEASE FORM

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I understand that the District’s liability coverage only applies to injury if negligence is proved against the District, and if the terms and conditions of the contractual liability coverage provided in favor of the District have been met. In all other circumstances, the student should seek coverage from his/her own healthcare insurer, and/or the negligent third party responsible for causing the injury.

****************************************************************************** In case of accident or serious illness, I request that the school/trip leader contact me. If I cannot be reached, I hereby authorize the school/trip leader to call the physician or hospital indicated below and follow his/her/its instructions. If it is not possible to contact this physician/hospital, the school/trip leader may make whatever medical arrangements are necessary. If there are any special instructions regarding medical treatment of my child, including any information regarding allergies or drug reactions, I have included the information below on the “Special instructions” line. I have legal custody or control of my child and grant permission for any emergency treatment and/or hospital services that may be rendered to said child under the general or specific direction of: Name of doctor or hospital emergency department: ___________________________________________ Telephone number of doctor or hospital: (______) _______-__________ Special instructions: ___________________________________________________________________ Parent/legal guardian name: _________________________________Phone #: (_____) ______-_______ (Please print) Home address: _______________________________________________________________________ Signature of parent/legal guardian __________________________________________________________