St. Mary School

Riverside, Illinois

Grade Kindergarden First Grade Second Grade Third Grade Fourth Grade Fifth Grade Sixth Grade Seventh Grade Eighth Grade , will participate in a field trip at

Date of Trip: Time of Departure: Time of Return:

Purpose of trip:

Type of transportation:

Type of Supervision:

Type of lunch:

Clothing Requirements:

Cost/Child:

I, the parent/ guardian of

request St. Mary School to take my son/ daughter on a field trip to

for an off-campus learning experience on

In the event of an emergency you can reach me at the following numbers:

Father/ Guardian(Home Phone)(Work Phone)

Mother/Guardian(Home Phone) (Work Phone)

Parent Signature

Please detach and return the lower portion of this field trip information form along with $ by.

Make checks payable to St. Mary School.

Number of chaperones: One Two Three Four Five Six Number of teachers: One Two Three Four Five Six

Do you wish To chaperone? Yes No

NB: IF A SCHOOL LUNCH WAS ORDERED FOR THAT DAY, A COLD LUNCH MAY BE SUBSTITUTED.

Yes, Please substitute a cold lunch

No, I will send a cold lunch.

Person(s) in charge:

 

Supervision:

 

Lunch:

 

Clothing:

 

________________________________________

Parent Signature