6th/7th Grade Trip to Port Townsend

Student First Name *

Student Last Name *

Itinerary:

Dates: June 4 and 5, 2024
Activity: Field Trip to Fort Worden for 6th and 7th grade students
First Student Charter buses will transport students.
Arrive at NOVA at 8:40 am on June 4.
We will return to NOVA around 3:30 pm on Wednesday, June 5.

Contact Person: Linda Manning "Mo" at lmanning@novaschool.org or 360-491-7097.

Phone Permission

On the 6/7th grade trip to Port Townsend, students will be allowed to use their cell phone for pictures only. Phones will be collected prior to loading the buses and before bed. Let us know whether or not your student will be bringing their phone. *

My student will bring their phone.

My student will not be bring their phone.

Medical Authorization

I/we, the undersigned parents and/or guardians of above student, a minor, do hereby grant permission to the responsible adults supervising on this school field trip, to any hospital, to any physician, or any other organization providing medical treatment to treat said student during this field trip in the event that we are not readily available to give our permission for such treatment. I/we agree to hold any responsible adult who gives permission harmless and to release that individual from any liability in connection with granting such permission for treatment and, furthermore, we do hereby release, acquit, discharge, and covenant to hold harmless, NOVA School, its agents and employees, from any and all actions, claims, demands, damages, costs, loss of services, expenses and compensation, on account of, or in any way growing out of the granting of permission for any emergency medical care for my/our student during their participation in the described trip.

I/we acknowledge that I/we have carefully read the foregoing medical authorization. I/we have reviewed the itinerary and give permission for my child to participate. I/we expressly recognize that they are responsible for their behavior and that all school rules of conduct apply while participating. *

Yes

Parent/Guardian First Name *

Parent/Guardian Last Name *

Primary Phone 1 *

Email 1 *

Parent2/Guardian First Name

Parent2/Guardian Last Name

Primary Phone 2

Email 2

Primary Contact Information:

Medications

Does your child have any medications (prescribed or over-the counter), pertinent health information, or dietary needs for 6/7th Grade Trip? *

Yes

Students who need to take prescribed medications of any kind, including over the counter medication, during this overnight trip are required to complete a Medical Authorization Form (for Administration of Medication at School). Please follow these procedures:

Parent obtains the Authorization form from the NOVA website, completes and signs the form.
If the medication is prescribed, parent takes the form to the physician for orders and signature.
If the medication is over-the-counter, only the parent needs to complete the form.
The parent returns the completed form and provides only the required number of doses of medicine in the original container labeled with the student’s name and directions to school.

Name of Medication(s) to be administered during 6th/7th Grade Trip:

0/255 characters

Authorization for Administration of Medication at School Form is on file at NOVA?

Yes

Health Information, Food Allergies, Dietary Restrictions or Other Information

Does your child have any food restrictions? *

Yes

If your child has any food allergies, dietary restrictions and/or dietary preferences, please complete the boxes below.

Food Allergies:

Dietary Restrictions:

Dietary Preference:

Other:

Signature

I certify that the information I have provided above is accurate to the best of my knowledge. As a parent/guardian of the above student, I give my permission for his/her participation in the NOVA School 6/7th Grade Trip to Port Townsend. *

clear

Your Name *

Relationship to Student : *