8/8/2019 Physics Field Trip Form

1/1

Paid: $______________Check #______________

Receipt #______________

Form SB60531 revised 8/1/96 BG-FTLTR.DOC

SCHOOL DISTRICT OF HILLSBOROUGH COUNTY

Application for Participationin Instructional Field Trips

This form is used for recording student requests to participate in instructional field trips and their parent or guardians permission forthem to participate and travel in specified transportation. It must be on file before a student may participate.

Student Request

I, ________________________________________________ am a student in Physics I, Physics IH or AP PhysicsPrint Student Name Print Name of Class

class at Bloomingdale Senior High school; My Period 2 (Attendance) Teacher is _____________________________.

My home address, including parent/guardian name : _______________________________________________________________Print Parent/Guardian Name

_____________________________________ __________________________________ ___ _____________________Print Home Street Address City State Zip

___________________________ _________________________ ___________________________Home Phone Work Phone Cell Phone

The intent of this voluntary statement is to form an agreement in which I pledge my compliance with the policies in the HillsboroughStudent Handbook and to conduct myself on all field trips in such a manner as to bring honor to my school and myself in returnfor the privilege of being included as a participant in field trip activities. I will, to the best of my ability, stay academically eligible bymaintaining at least a 2.0 grade point average._______________________________________________________________ ___________________________________

Students Signature Date

Parent/Guardian Request

As parent or guardian, I request that ___________________________________________________________ bePrint Students Name

included in the field trip to ___Busch Gardens, Tampa,_ that will be conducted on December 3, 2010, from 7:33 A.M. to 2:59 P.M.Print Name of Trip Destination Month/Day/Year

I understand that transportation will be provided by:

A private automobile of a parent, teacher, and/or licensed student, none of which isunder the control of the School Board of Hillsborough County.

or A Hillsborough District School bus.

or A private bus under charter to the Hillsborough County School Board.

_______________________________________________________________ ___________________________________Signature of Students Parent or Guardian Date of Signature

Additional Information1. Cost of trip is $53.00; NO REFUNDS. Please make checks payable to BLOOMINGDALE HIGH SCHOOL.2. If a student has a valid pass to enter Busch Gardens, the cost of the bus trip only is $14.00.3. Money with permission forms are due on or before Friday, November 05, 2010.4. We need 7 parental chaperones. Chaperones pay nothing except for their own lunch. Contact Mr. Brod at 744-8018

(voice mail extension 427); e-mail jbrod1@tampabay.rr.comor just send a note if you wish to chaperone. Chaperones are acceptedon a first-come, first-served basis.

A copy of this form must be turned into office three days prior to the field trip.