Night Owls Field Trip Permission Form Student Name: Parent Name: Parent Contact Number: Additional Emergency Contact: Phone: School: By signing this form, you are indicating that the Night Owls program has your permission to attend the Night Owls Peter Piper Lock In under the Kyrene School District’s staff care during the scheduled dates/times at the scheduled location. Day Date Fri –Sat 01-30-15 01-31-15 Field Trip Information Peter Piper Pizza 4940 East Ray Road Ahwatukee, AZ 85044 480-893-0995 Parent Pick Up/Drop Off Time: Drop Off: 11:00 p.m. Pick Up: 6:00 a.m. Special Instructions/Information Parent Signature Pre-registration and field trip permission form required 2 business days before field trip date. No bus transportation will be provided for the field trip. Participants to meet directly at venue. Please have student dress comfortably and bring sleeping bag and pillow for rest/relaxation time. X I understand that the District’s liability coverage only applies to injury if negligence is proved against the District, and if the terms and conditions of the contractual liability coverage provided in favor of the District have been met. In all other circumstances, the student should seek coverage from his/her own healthcare insurer, and/or the negligent third party responsible for causing the injury. Please fax field trip form to 480-541-1815, ATTEN: Night Owls Field Trip. Field trip form must be received to go on the field trip.
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