Editing previous response:

Please fix the highlighted areas below before submitting.

7th & 10th grade permission slip

Location: Spruce Lake Camp

Date: April 15, 2025

Departure & Return times: Leaving school at 8:00 a.m. and arriving back at school at 2:35

Cost: $18.00

Lunch: Bring a bagged lunch

Dress Code: Jeans, t-shirt/sweatshirt, and sneakers. Also bring a pair of boots or old sneakers and an extra pair of socks for the wetlands section.

Transportation: Bus/Vans

Chaperones: The trip will be chaperoned by Miss Timlin and Mr. & Mrs. Farnsworth

Emergency Phone numbers: Miss Timlin 717-475-7739

Student First & Last Name*

Answer Required

Grade*

Answer Required

Parent/Guardian First & Last Name*

Answer Required

Parent/Guardian Phone Number*

Number Required

Emergency Contact Name*

Answer Required

Emergency Contact Phone Number*

Number Required

Family physician*

Answer Required

Family physician phone number*

Number Required

Special medical conditions:

Answer Required

I give my consent as the parent or guardian of the above named student to participate in this event. In doing so, I agree to the following:

In case of a medical emergency, I grant the chaperones the right to authorize medical care, if none of the persons named above can be reached.
I agree to pay the expenses of returning my child home before the end of the event if he or she does not adhere to the established standards of conduct.
The school is not responsible for damage or loss of property personally owned by my child.

Pay by debit/credit card

Answer Required

Price: $18.00

I will pay by cash or check made payable to CCA

Answer Required

18.00

Parent/Guardian Signature*

Signature Required

Note for teacher:

Answer Required

Confirmation Email

Confirmation Email *

Email Required