San Ramon Valley Unified School District
Danville, California 94526

Parental Permission for Field Trip

My daughter/son _________________________ has my permission to participate in a field to _____________________________________________. I understand that transportation will be by______________________________________________ and they will leave school at ________________ and return at approximately____________. The date(s) of the trip is/are __________________________. In the case of an accident of emergency I authorize the school to seek medical, surgical, or hospital attention for my child. It is understood that every attempt will be made to contact me before taking this action. I understood that any field trip involves certain dangers in addition to transportation and hold the District and its representatives harmless from claims or liabilities arising from this trip.

Telephone #________________________________________________________
			(work)			(Home)		(emergency)

Signature__________________________________________________________
					Parent or Guardian

Athlete’s Name_______________________________ 	D.O.B._____________

Address_____________________________________

Phone__________________home	_____________________cell

Phone__________________work	_____________________other

Email(s)____________________________________________________________

Medical Information:

I give the coach’s permission to administer the following medications to my child:

_____Aspirin		_____alka seltzer	______Imodium A-D		_____Tylenol

_____Pepto Bismol	_____other____________________________________________

Medicine(s) in athlete possession_____________________________________________

List any allergies to medications/food:_________________________________________

Date of last tetanus______________________

List any pertinent medical history or chronic medical problems________________________________________________________________________________________________________________________________________________________________________________________________________________