Marshall School District
Trip Approval &
Emergency Medical Authorization
Student: __________________________________________________
Teacher: __________________________________________________
Destination: _______________________________________________
Date of Trip: _________
I, the undersigned parent/guardian, do give my permission
for the above-named student to attend the field trip of date. I also give my
permission for authorized school personnel to seek and obtain emergency medical
treatment if they deem necessary. The school, authorized person, or medical
treatment facility will make every reasonable attempt to notify the
parent/guardian prior to such treatment. If contact is unsuccessful, then emergency
treatment can proceed.
Parent/Guardian: ___________________________________________
Date ________________
Home Phone: _____________________________ Work Phone:
_________________________
Alternate Person: _________________________________
Alternate Phone: ________________
Medical Insurance Company:
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Other information:
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Parent/Guardian Signature:
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