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Emergency Card and Field Trip Release
Child's Last Nameyour full name
Child's First Nameyour full name
Languagepick one!
Birthdateof appointment
Home Phone Numberyour full name
Address (Street, City, State, Zip)your full name
Father's Nameyour full name
Mother's Nameyour full name
Father's Cell Phone Numberyour full name
Mother's Cell Phone Numberyour full name
Father's Workplaceyour full name
Father's Workplace Phone Numberyour full name
Mother's Workplaceyour full name
Mother's Workplace Phone Numberyour full name

Emergency Contacts

Name of First Emergency Contactyour full name
Relationshipyour full name
Phoneyour full name
Name of Second Emergency Contactyour full name
Relationshipyour full name
Phoneyour full name
Primary Physician Nameyour full name
Phoneyour full name
Dentistyour full name
Phoneyour full name
Languagepick one!
Preferred Hospitalyour full name
Allergies or illnesses we should be aware ofyour full name
Other people besides parent and emergency contacts who have permission to pick up your child from schoolyour full name
Parent Name (this serves as your signature)your full name
Date

FIELD TRIP RELEASE FORM

(NOTE: The Field Trip Release Form is primarily only used by the Pre-K classroom. It is VERY rare that our other classes take field trips.) 


Children learn best by having opportunities to see for themselves, to touch, taste, smell, and hear new experiences.  As they discuss their new experiences, opportunities are presented for expanding the child’s knowledge.  Field trips provide children firsthand information, observation, study and broadening of concepts.

First English Lutheran Preschool has my permission to arrange carpools to transport my child, 

Child's Nameyour full name

on planned trips away from the preschool.  Every possible precaution will be taken to ensure the health and safety of my child.  I will provide a car seat for my child to be transported to and from field trips. I will be given information prior to each trip that my child will be offered to attend.  I myself can provide transportation for my child for the Field Trips.  Each child attending any field trips, and the parents or primary caregivers of such child, shall assume all risks of loss or damage and expressly release the First English Lutheran Preschool, its trustees, teachers, and all other agents and employees for liability therefore.

Parent/Primary Caregiver Signatureyour full name
Dateof appointment
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