TEQUESTA TRACE MIDDLE SCHOOL WESTON FLORIDAAUTHORIZATION FORFIELD TRIPIWE the undersigned hereby grantStudents name ID number permission to participate in a Tequesta Trace Middle sponsored trip toUN ID: 895895
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1 THE SCHOOL BOARD OF BROWARD COUNTY FLORI
THE SCHOOL BOARD OF BROWARD COUNTY FLORIDA TEQUESTA TRACE MIDDLE SCHOOL – WESTON, FLORIDA AUTHORIZATION FOR FIELD TRIP I/WE, the undersigned, hereby grant_________________________________________________________ ______ (Student’s name) (ID number #) permission to participate in a Tequesta Trace Middle sponsored trip to: UNIVERSAL STUDIOS, ORLANDO, FLORIDA As a member of : 7 TH GRADE CLASS Mode of Transportation : CHARTERED BUS TSHIRT SIZE AD ULT: SMALL _______ MEDIUM _______LARGE _______X LARGE _______ XX LARGE ______ DEPARTURE TIME : 5: 3 0 am PLACE TEQUESTA TRACE DATE: MARCH 16, 2020 RETURN TIME : 10:30 PM PLACE TEQUESTA TRACE DATE : MARCH 16, 2020 COST $145.00 PAYMENT DEADLINE: DECEMBER 1 1 , 2019 Field trip must be paid online at osp.osmsinc .com Select Middle School/Tequesta Trace/Select grade trip. CASH WILL NOT BE ACCEPTED . Student’s ID number is required for payment (and all obligations must be paid). THIS FORM MUST BE COMPLETED AND RETURNED TO : KATHY SALERNO PE prior to December 19 th , 2019. ************************************************************************************************** ***** EM ERGENCY CONTACT INFORMATION Please provide your phone numbers _____________________________( PARENT CELL ) Back up contact ___________________________________________(name) _____________________________(phone) Does your child take any form of medication, have any allergies, or special health
2 problems? _____Yes _____No If yes, p
problems? _____Yes _____No If yes, please explain: _ ________________________________ __________________________________________ Does your child need to take ANY medication on THIS trip? _____ No _____ Yes If YES, PARENT MUST FILL OUT MEDICATION AUTHORIZATION FORM AT SCHOOL PRIOR TO FIELD TRIP (Doctor and Parent signature required ) HEALTH/A CCIDENT INSURANCE My child is covered by twenty - four - hour accident insurance or family health insurance. Insurance Company: _ ___________________________________ Policy #_____________________________________ __________ I do not have insurance; however, I WI LL PAY for any and all medical bills for the emergency care of this student. ******************************************************************************************************* A student who receives any of the following will lose his/her privilege to attend trip and will forfeit all monies paid towards the trip: Administrative referrals/Alternative to suspension or external suspension. Students unable to attend the field trip due to circumstances beyond the school realm will receive a monetary refund i f final deposits and payments have not been made. Otherwise students will receive their park ticket and t - shirt . If student does not attend field trip the day of , there will be no compensation or monetary refund. ADMINISTRATOR SIGNATURE: _ ______________ _________________________ Parent/Guardian Signature ______________________________________________________ Student Cell phone number ______________________________________________________ **By signing, I confirm I have read all the above information pertaining to the field trip.