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* 1. What is the student's last name?

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* 2. What is the student's first name?

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* 3. What is the student's email address?

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* 4. What is the parent/guardian's email address?

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* 5. What is the student's cell phone number?

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* 6. Who is the student's emergency contact?

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* 7. What is an emergency contact number for the student?

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* 8. Below is a list of any medical concerns that field trip chaperones should be aware of.  This may include medications I take, foods I am allergic to, if I carry an inhaler, or anything else that is important for medical purposes.

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* 9. I understand that I MUST turn in the hand-signed permission slip to Kaci Sintek (kaci_sintek@dpsk12.org) in the main office in order to be able to go on any school field trips.  I understand that this permission slip must be given to her before getting on the bus to be eligible to attend any of the field trips.  I understand that a typed permission slip does NOT meet the requirements; I understand it must be hand-signed by my parent/legal guardian.

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* 10. I understand that I must be on time to ride the bus, and if I am not, the bus may leave without me.  I understand that food is not provided, and that I should bring my own water/snacks/lunch or money should I get hungry. 

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