7th Grade Spring Term 2015-Trip Permission Slips & Ordering Forms CHARLESTON CHARTER SCHOOL FOR MATH AND SCIENCE Field Trip Permission & Ordering Form Please read the description of our spring term trips below, and then fill out the permission slip. By signing this slip you agree to the field trips & the mode of transportation being used. A more detailed look at the trip is attached. Please return this permission slip by: Friday- 5/15/15 to 1st block or Mrs. Wolfrey My son/daughter _______________________________________________ has permission to participate in all Spring Term activities as described below, I have read the fieldtrip outlines attached and agree to send my student prepared for the day. ___________________________________________________________ TRIP 1: Wednesday, May 27th, 2015- Grow Carolina- Walking Trip – Lunch on campus Chaperone Options: ☐YES, I would like to Chaperone and I will check in with the front office the morning of the trip then join you on the walking trip. ☐YES, I would like to Chaperone and I will check in with the front office the morning of the trip then join you with my own transportation. ( I understand that the only way I can drive my student to and from the trip is by checking them out of the front office.) ☐NO, I will not be able to Chaperone (please complete the emergency contact information below) TRIP 2: Friday, May 29th, 2015- Folly Beach & Food truck tripLunch off campus Food Options: Option 1: ☐YES, I would like to order a bag lunch from the school cafeteria: ☐Enclosed is money for my child’s bagged lunch in the amount of: $_________. ☐My child has money on his/her lunch account and the number is _____________. Option 2: ☐My child will bring a packed lunch from home on this day. Option 3: ☐I will send my child with money to purchase food from a food truck on the island that day. 7th Grade Spring Term 2015-Trip Permission Slips & Ordering Forms Chaperone Options: ☐YES, I would like to Chaperone and I will check in with the front office the morning of the trip then join you on the bus. ☐YES, I would like to Chaperone and I will check in with the front office the morning of the trip then join you with my own transportation. ( I understand that the only way I can drive my student to and from the trip is by checking them out of the front office.) ☐NO, I will not be able to Chaperone (please complete the emergency contact information below) Trip 3: Monday, June 1st, 2015- MUSC Urban Farm/Restaurant Visit & Lunch/ Park trip- Lunch paid & off campus__________ Food Options: (CHOOSE ONE RESTAURANT & 1 MEAL FROM THAT RESTAURANT) there are only 20 spots open at each venue, so first come, first served. ☐Virginia’s on King Choose from: ☐Grilled cheese sandwich/tomato soup ☐Half Shrimp Po'boy with ☐fruit or☐ French fries ☐Chicken tenders with ☐fruit or☐french fries ☐Mac n Cheese with side of broccoli ☐Tabulli Choose from: ☐Classic Gyro with fries -Gyro, fresh lettuce, tomatoes, carmelized onions, tzatziki sauce, and pita ☐Kofta Burger with fries-House-ground lamb & beef, tomatoes, red onion, drizzled with tzatziki sauce topped with feta. ☐Mezze Mix Box Lunch-Sauteed chickpeas, cucumber, tomato, tabbuli salad,romaine, hummus, tahini, sriracha, Whisk's viaigrette ☐Stuffed Pita-Grilled pita stuffed with feta cheese, provolone cheese, tabbuli salad, served with a side of tzatziki sauce, Jerusalem salad and roasted red pepper coulis. ☐Poogan’s Porch** peanut oil is used here to cook all dishes.** Choose from: ☐Pulled Pork Sandwich with house made chips ☐ Fried Chicken Salad with field greens, fresh vegetables, and honey jalapeno dressing ☐Salmon with mashed potatoes and green beans ☐Rue de Jean Choose one Entrée & Desert. 7th Grade Spring Term 2015-Trip Permission Slips & Ordering Forms Entrée- Choose 1: ☐Quiche du Jour – quiche of the day served with a small side salad ☐House smoked turkey sandwich – Turkey, tomato, red onion, gruyere, and avocado. Served with pommes frits.(Dairy allergy and nut allergy with the fries) ☐French Dip – Roasted chuck, Gruyere, horseradish aioli, and natural jus. Served with pommes frits.(Dairy/nut allergy) ☐Ratatouille vegetables – Mixed vegetable plate if a vegetarian option is needed. Desert – Choose 1: ☐Chocolate pate – Dark chocolate pate, served on crème angles and strawberry coulis ☐Raspberry Sorbet Chaperone Options: ☐YES, I would like to Chaperone and I will check in with the front office the morning of the trip then join you on the walking trip. I WILL PURCHASE MY OWN FOOD (For $18.00- tax, service charge included), I WOULD LIKE TO ATTEND _________________ RESTAURANT & EAT_______________________. MY CHECK/CASH IS ATTACHED. ☐YES, I would like to Chaperone and I will check in with the front office the morning of the trip then join you with my own transportation. (I understand that the only way I can drive my student to and from the trip is by checking them out of the front office.) I WILL PURCHASE MY OWN FOOD ( FOR $18.00), I WOULD LIKE TO ATTEND _________________ RESTAURANT & EAT_____________________. MY CHECK/CASH IS ATTACHED. ☐NO, I will not be able to Chaperone (please complete the emergency contact information below) ___________________________________________________________ ALLERGIES He/She is allergic to _________________________ and I have noted his/her physical limitations on the back of this form. Has the school nurse been made aware of the allergy? ☐YES ☐NO* [* If no, school nurse and field trip sponsor must be notified immediately] * In case of an Emergency, I may be reached at: Name of Parent/Guardian: Printed Name ___________________________________________________ Address City Zip Code Home/Cell Phone:__________ Work Phone: ________ Other:____________ If I cannot be reached in the event of an emergency, the following person is authorized to act on my behalf: 7th Grade Spring Term 2015-Trip Permission Slips & Ordering Forms Emergency Contact: (Print name) Home/Cell Phone: ______ Work Phone: ________ Other: _____________ Relationship to Parent/Student: ______________________________________________ STUDENT PLEDGE I pledge that my conduct will, at all times, reflect credit upon myself, my parents, and my school. I understand that the school rules of conduct apply while on the trip. ___________________ (Student’s Signature) ____/___/____ (Date) CONSENT By signing this form, I declare that I am the legal parent/guardian of the minor child listed above and authorized to grant such permission. I have read the field trip itinerary and understand that there are risks of physical injury associated with participation in these activities. I authorize qualified emergency medical professionals to examine and in the event of injury or serious illness, administer emergency care to the above named student. I understand every effort will be made to contact me to explain the nature of the problem prior to any involved treatment. In the event it becomes necessary for the school district staff-in-charge to obtain emergency care for my student, neither he/she nor CCSMS assumes financial liability for expenses incurred because of the accident, injury, illness and/or unforeseen circumstances. These activities are an extension of the school’s education program and student conduct is to be in accordance with the school’s published rules and regulations. _______________ _____/_____/______ (Parent's Signature) (Date)
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