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Honor Society permission slip

Location: U.S. Army Heritage and Education Center

Date: April 12, 2025

Departure & Return times: Leaving school at 8:00 a.m. and arriving back at school between 5 and 6 p.m.

Cost: $0 for the education center; money is needed for Cracker Barrel for lunch

Dress code: Casual

Transportation: School vans

Chaperones: The trip will be chaperoned by Mr. & Mrs. Musser

Emergency Phone number: Mrs. Musser 570-856-0773

Student First & Last Name*

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.

Parent/Guardian Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required