©Nakali Consulting, Inc 2010 l Field Trip Permission Form

FIELD TRIP PERMISSION FORM

.

I give my permission for my child, _____________________________________, to

leave ______________________________________for supervised trips via car or

public transportation to special places such as:

• the Public Library • the Zoo or Museum

• the Park • Public Events

• Other___________________________

Restrictions on such trips for my child include:

_____________________________________________________________________

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_____________________________________________________________________

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Signature of Parent or Guardian Date

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Signature of Parent or Guardian Date