Learning Together Preschool
Learn ~ Grow ~ Thrive
Authorization for Field Trip
I hereby authorize Richard and/or Cathy Larson to take my child on excursions into the community. These outings may be made on foot or by automobile as the occasion warrants. I also understand that when traveling the teachers may drive or use a volunteer to drive. At no time will teacher or volunteer attempt emergency transportation of my child unless accompanied by another adult.
Child's Name:_________________________________________
Parent/Guardian Signature:_______________________________Date:____________________
Parent/Guardian Signature:_______________________________Date:____________________
IN CASE OF EMERGENCY CALL
Parent/Guardian Name:_________________________________Phone:____________________
Parent/Guardian Signature:______________________________Phone:____________________
MEDICAL RELEASE
I hereby grant permission for Richard or Cathy Larson to take whatever steps may be necessary to obtain emergency medical treatment if warranted. I consent to medical or surgical treatment by any licensed physician and/or hospital and further consent to administration of necessary anesthetics, medical treatments, tests, transfusions, injections, or drugs, and performing whatever operations may be deemed necessary or advisable in the event of an emergency.
Child’s Name:___________________________________________________________
Parent/Legal Guardian
Signature:_________________________________________Date:_________________
PLEASE NOTE: ALL ATTEMPTS WILL BE MADE TO CONTACT PARENT OR LEGAL GUARDIAN PRIOR TO MEDICAL TREATMENT OF ANY KIND IF POSSIBLE WITHOUT ENDANGERING THE LIFE OR MEDICAL CONDITION OF YOUR CHILD.
Drug Allergies:___________________________________________________________
Doctor:_____________________________________Phone:_______________________
DO NOT PICK UP YOUR CHILD IN ROUTE
FOR CHILDREN WHO WILL CARPOOL WITH ANOTHER PARENT
I hereby grant permission for my child (write name)____________________________to ride in (write
name)________________________________________’s vehicle.
Richard or Cathy Larson have seen the driver’s copy (write name of driver) _______________________________ of his/her Oregon state driver’s license and liability car insurance card.
Name of parent:___________________________________________________
Signature of parent:________________________________________________
Date:____________________________________________________________
Name of child:_____________________________________________________
Child's Name:_________________________________________
Parent/Guardian Signature:_______________________________Date:____________________
Parent/Guardian Signature:_______________________________Date:____________________
IN CASE OF EMERGENCY CALL
Parent/Guardian Name:_________________________________Phone:____________________
Parent/Guardian Signature:______________________________Phone:____________________
MEDICAL RELEASE
I hereby grant permission for Richard or Cathy Larson to take whatever steps may be necessary to obtain emergency medical treatment if warranted. I consent to medical or surgical treatment by any licensed physician and/or hospital and further consent to administration of necessary anesthetics, medical treatments, tests, transfusions, injections, or drugs, and performing whatever operations may be deemed necessary or advisable in the event of an emergency.
Child’s Name:___________________________________________________________
Parent/Legal Guardian
Signature:_________________________________________Date:_________________
PLEASE NOTE: ALL ATTEMPTS WILL BE MADE TO CONTACT PARENT OR LEGAL GUARDIAN PRIOR TO MEDICAL TREATMENT OF ANY KIND IF POSSIBLE WITHOUT ENDANGERING THE LIFE OR MEDICAL CONDITION OF YOUR CHILD.
Drug Allergies:___________________________________________________________
Doctor:_____________________________________Phone:_______________________
DO NOT PICK UP YOUR CHILD IN ROUTE
FOR CHILDREN WHO WILL CARPOOL WITH ANOTHER PARENT
I hereby grant permission for my child (write name)____________________________to ride in (write
name)________________________________________’s vehicle.
Richard or Cathy Larson have seen the driver’s copy (write name of driver) _______________________________ of his/her Oregon state driver’s license and liability car insurance card.
Name of parent:___________________________________________________
Signature of parent:________________________________________________
Date:____________________________________________________________
Name of child:_____________________________________________________