Wayzata High School Travel Form: General Information and Consent
Please complete this form prior to participating in any school-sponsored travel.
Student Name:
*
First Name
Middle Name
Last Name
Student Email Address:
*
example@example.com
Student Phone Number:
*
Please enter a valid phone number.
Student Birthday:
*
-
Month
-
Day
Year
Date
Location of trip:
*
Organizing Teacher, Advisor, or Coach Name:
Prefix
First Name
Last Name
Organizing Teacher, Advisor, or Coach Email Address:
*
example@example.com
Date(s) of trip:
*
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Email Address:
*
example@example.com
Parent/Guardian Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number:
*
Please enter a valid phone number.
Emergency Contact:
*
First Name
Last Name
Emergency Contact Phone Number:
*
Please enter a valid phone number.
Student's Primary Physician:
Prefix
First Name
Last Name
Student's Primary Physician Phone Number:
Please enter a valid phone number.
Student's Insurance Company:
Student's Insurance Policy Number:
Insurance Policy Holder Name:
First Name
Last Name
Student's medications to be brought on the trip:
Please include dosages and frequency.
Additional information:
Please share anything that would be helpful for the Organizing Teacher, Advisor, Coach, or an Administrator to know regarding you participating in this opportunity.
Rules Students Must Understand and Observe and Parent/Guardian must support
All School District #284 policies and regulations will be in effect. Infractions of School District 284, Minnesota State High School League, and/or team/group policies and regulations during a trip will result in disciplinary measures.
Possession or use of alcohol, or any beverage containing alcohol, will result in the termination of the trip. School and extra-curricular
consequences will also be incurred.
Possession, use, purchase, sale, or exchange of tobacco, marijuana, or any substance defined by law as a drug other than those
prescribed by a student’s physician will result in the termination of the trip. School and extra-curricular consequences will also be incurred.
Misconduct during the trip will result in notification of parent/guardian, and the student may be sent home at parent/guardian
expense. If the parent/guardian cannot be reached, the number of the neighbor, friend, or relative listed above will be contacted.
I have read, understand, and agree to the above rules.
Student Signature:
*
Click submit to send approval/signature request to parent/guardian.
Please remind your parent/guardian to check their email.
Submit
Should be Empty: