GASTON COUNTY SCHOOLS
PARENT/GUARDIAN PERMISSION FOR SCHOOL FIELD TRIP

DAY TRIP

Student: ____________________________________________
School: Mt. Holly Middle School      Date: 05/14/01
Teacher/Class: Sharks Team

TRIP INFORMATION:

Place:      McDonalds in Mt. Holly                                                                
Date: May 22, 2001 Departure Time:    11:30 a.m.
Return Time:    1:00 a.m.
Method of Transportion:   Walking
Admission:   No Charge     Miscellaneous Cost:     Lunch   

Retain this part for your information

Detach and Return to School

________________________________ has my permission to go on the trip to McDonalds in Mt. Holly on 05/22/01.    In case of an accident or illness, the teachers and/or chaperones for this field trip have my/our permission to seek emergency medical care or treatment.

Signature of Parent/Guardian: _______________________________________________

Date: _______________________

Contact in Case of Emergency:

Name: _____________________________________________

_________________  (Home Phone No.) _________________   (Work Phone No. ) 

Name: _____________________________________________

_________________  (Home Phone No.) _________________   (Work Phone No. )