5th Grade Philadelphia Trip – Release Form and Payment Link

Be sure to:

complete the form below as the permission/release form for the trip
complete your Paypal payment on the next screen, after clicking “Submit” below to submit the trip fee

5th Grade Philadelphia Trip Release Form & Payment

Student Name*
First Last
Indicate any food allergies or restrictions for the student. Please note that you must provide a pareve lunch for your child, extra snack and a disposable water bottle. (Leave blank if no food allergies)
Use this space to note any updates to the Parent Contact Information already on file for you at school. (Leave blank if no update.)
Use this space to list any medical updates beyond what the school has on file for your child. Please also list all medications that your child will need to take during the trip.
Please be sure to send all prescription medicines in original pharmacy packaging with specific instructions indicated.
Use this space to note anything else you want to share pertinent to the trip/program. (Leave blank if nothing to note.)
I would like to be a parent chaperone on this trip*
- Yes
- No
Not all parent chaperone volunteers will be selected, as we have limited space on the bus. Parents will be notified by __________ if selected to chaperone.
Parent Email*
Parent Name for Electronic Signature*
First Last
Electronic Signature*
- I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document or form.
5th Grade Philadelphia Trip Fee
Price: $36.00
Total
$0.00
IMPORTANT INFORMATION ABOUT PAYMENT
When you click "submit" below, your release form is submitted, but your payment is NOT YET submitted. After clicking "submit," you will be automatically redirected to a Paypal login page which will be based on your Total $$ due for this item. Your payment IS NOT COMPLETE until you have submitted payment via that link, or have sent a check payable to KSDS (attn: Karen Booth) for the total amount due. IF you do not see a confirmation email in your inbox after clicking "Submit," please check your Spam folder.

5th Grade Philadelphia Trip – Release Form and Payment Link

5th Grade Philadelphia Trip Release Form & Payment

IMPORTANT INFORMATION ABOUT PAYMENT