Field Trip Parent Permission and Medical Information Form

Collects guardian permission, emergency contacts, and essential medical and allergy information for a student field trip, with consent and emergency response details.

Trip Notice and Consent

• Field Trip Name
• Trip Date
• I give permission for my child to participate in this field trip.
• I understand this form collects limited personal and health-related information for trip safety and emergency response.
• I understand that staff will use the information provided only for supervision, emergency response, and trip coordination.

Student Information

• Student Full Name
• Grade or Class
• Student Date of Birth
  Optional. Only collect if needed to confirm age-related trip requirements.
• School or Program Name

Guardian and Emergency Contacts

• Parent or Guardian Full Name
• Relationship to Student
• Primary Phone Number
• Email Address
• Emergency Contact Name
• Emergency Contact Phone

Medical and Allergy Information

• Does the student have any medical conditions staff should know about?
• Medical Condition Details
  Include only information relevant to trip safety and emergency response.
• Does the student have any allergies?
• Allergy Types
• Allergy Details and Severity
  List the allergen, typical reaction, and any emergency instructions.
• Will the student need medication during the trip?
• Medication Details
  Include medication name, timing, and any staff instructions. Do not include unnecessary health history.
• Additional Health Notes
  Optional. Use for any other minimum-necessary information that would help staff support the student safely.

Emergency Authorization and Pickup

• I authorize school staff to seek emergency medical treatment if I cannot be reached.
• Authorized Alternate Pickup Name
• Authorized Alternate Pickup Phone
• Special Instructions for Staff
  Include only instructions relevant to trip supervision, pickup, or emergency response.