Download Medieval Times Permission Slip

Teams Rubicon and Zambezi Field Trip to
Thursday, March 16, 2017
We will be traveling back in time to the Middle Ages at Medieval Times! Admission
includes lunch, a jousting match and competing knights using authentic medieval
weaponry.
We are asking each student to
Donate $35
Donations will cover the cost of the buses and admission for both our Medieval Times
trip and the Beach Trip planned for the end of the year.
-Please make $35 check payable to “Rio Norte ASB” (if possible, please don’t send cash)
If $35 is a hardship for your family, please send whatever you can and our team will make up the difference. If you are
able to donate a little bit extra to help another student, that would be awesome!
-We will not need parent chaperones for this field trip.
-We will leave at 8am and return between 2:30-3:00pm. Students will not be able to go
home from school using public transportation.
-Please sign and return the permission slip with the check or money by March 1, 2016.
Rio Norte Junior High School
Teams Rubicon and Zambezi Field Trip
Medieval Times, Buena Park, CA
• Field trip permission slip requires
parent signature in TWO locations.
Your child must return this form and your donation ($35 requested to help cover the cost of
admission and buses ) to your teacher no later than March 1, 2016.
PARENT’S OR GUARDIAN’S PERMISSION FOR FIELD TRIP
AND AUTHORIZATION FOR MEDICAL CARE
I agree to direct my student to be cooperative with directions and instructions of the school district personnel in charge of this
activity. I give my permission for my student to participate in the field trip to:
Tuesday, March 16, 2016
Bus leaves 8:00 a.m., returns to Rio Norte by 2:30-3:00 p.m.
Transportation by bus
Parent or guardian, please sign here:
_______________________________________________________
(Signature #1 gives permission to go on the trip)
Section 35330 of the California Education Code states in part: “All persons making the field trip shall be deemed to have
waived all claims against the district or State of California for injury, accident, illness, or death occurring during or by reason of
the field trip or excursion.”
AUTHORIZATION FOR MEDICAL CARE: Should it be necessary for my child to have medical care while participating in this
trip, I hereby give the School District personnel permission to use their judgment in obtaining medical care and ambulance
service for the child, and I give permission to the physician selected by the School District personnel to render medical care
deemed necessary and appropriate by the physician. I understand that the School District has no insurance covering such
medical or hospital costs incurred by my child and therefore, any cost incurred for such treatment shall be my sole
responsibility.
Student’s Name (Please print)_____________________________________ Date of Birth _________________________
Home Address _______________________________________________________________________________________
Home Telephone # _______________________________ Cell/Business Phone #________________________________
Parent/Guardian Name (Please print) __________________________________________________________________
Emergency Telephone # ____________________________________________ Date ______________________________
Authorization Signature of Parent/Guardian ____________________________________________
(Signature #2 gives authorization for medical care)
Instructions for special medical treatment ________________________________________________________________


Return this FULL PAGE permission slip, completely
filled out and signed in both places to your teacher by
March 1.
We are requesting a $35 donation to cover the cost of
the ticket and bus for the trip.

Vegetarian Meals are available upon Request, please
check the box if you WILL NEED a vegetarian meal.
Do not check the box if you would like a standard
meal.