Saintandrews.net

SAINT ANDREW’S UPPER SCHOOL
PERMISSION FORM
9TH GRADE TRIP
PATHFINDER

I, _________________________________________________, herby give permission
for my ( parent’s/ legal guardian’s complete name )
son/daughter, ____________________________________, to attend the Class Trip
below.
I fully understand and agree to hold harmless Saint Andrew’s School, and any other person engaged by Saint Andrew’s School to act on its behalf during the Class Trip, from any and all injuries, claims, losses or liabilities which may occur to my son/ daughter during the Class Trip. I further understand that my son/ daughter will be under the supervision of Saint Andrew’s and is required to follow its rules and requirements. __________________________________________________
Signature of Parent of Legal Guardian of Student
*************************************************************
Destination of Field Trip: Pathfinder, Ellenton, Florida
Date of Field Trip: Tuesday, January 14, 2014 – Friday, January 17, 2014
Time/ Periods Away From Campus: 4 days
Faculty Sponsor/ Coordinator: Andy Mulligan, Tammy Friedman, Nicholas Dorn
Ground Transportation will be arranged by Saint Andrew’s School for all students
departing campus on January 14 at 7:15 in the morning and returning on January
17 at 4:30 in the afternoon.
SAINT ANDREW’S SCHOOL
STUDENT INFORMATION
ACTIVITY PERMISSION / MEDICAL INFORMATION

Name of son/ daughter: _______________________________________________
Permission to Engage in Outdoor/Adventure Activities:
Please check off the following activities that the student above has permission to
perform:

____ Ropes Course
High Ropes: Ziplining, harnessed climbs up tires, beams, and other obstacles Low Ropes: Close to the ground team-building activity oriented stations (include tight rope/wire, rope swings) ____ Evening Bonfire with Smores ____ Outdoor team activities: fashioning lean-to’s, designing survival strategies, night hikes, team sports (soccer, Ultimate Frisbee, football, etc.)
Medical Information:
We have the medical forms families submitted at the beginning of the school year, but you
are strongly encouraged to identify any new prescription medications that your son/
daughter may be taking on our trip. Please provide the reason for the prescribed meds.
Medications (indicate dosage and reasons for taking):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Permission to Dispense Non-Prescription Medication
The following non-prescription medications may be administered to the above mentioned
student, if pertinent symptoms arise. Please check all that apply:

Imodium AD ______

Source: http://www.saintandrews.net/uploaded/Student_Life/Path_Finder_-_Permission_and_Medical_Release_Forms.pdf