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Run: Field Trip Parent Permission and Medical Information Form

A field trip parent permission and medical information form for collecting guardian consent, emergency contacts, allergies, medication needs, and pickup auth...

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Trip Notice and Consent

Field Trip Name (required)

Trip Date (required)

I give permission for my child to participate in this field trip. (required)

Yes No N/A

I understand this form collects limited personal and health-related information for trip safety and emergency response. (required)

Yes No N/A

I understand that staff will use the information provided only for supervision, emergency response, and trip coordination. (required)

Yes No N/A

Student Information

Student Full Name (required)

Grade or Class (required)

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 (required)

Relationship to Student (required)

Primary Phone Number (required)

Email Address

Emergency Contact Name (required)

Emergency Contact Phone (required)

Medical and Allergy Information

Does the student have any medical conditions staff should know about? (required)

Medical Condition Details

Include only information relevant to trip safety and emergency response.

Does the student have any allergies? (required)

Allergy Types

Allergy Details and Severity

List the allergen, typical reaction, and any emergency instructions.

Will the student need medication during the trip? (required)

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. (required)

Yes No N/A

Authorized Alternate Pickup Name

Authorized Alternate Pickup Phone

Special Instructions for Staff

Include only instructions relevant to trip supervision, pickup, or emergency response.

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Email (required)

Your name (optional)

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