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)