Apple Picking Field Trip

Field Trip Details Location Red Apple Farm

Phillipston, MA

What To Bring
Bagged Lunch $10 for Apples, Hayride, etc. Light Jacket (depending on weather)

Date Sept 25th 2011 Departure Time 11:30 AM @ UPC Return Time 3:00 PM @ UPC Transportation Carpool from UPC Jerrys Cell # 978-618-0909

Cut off bottom portion of permission slip return to the Youth Group by Sept 25th 2011. Emergency Information In case of emergency, please contact: ___________________________________________________________ __________________________
Name/Relationship Phone

Special Instructions:

I give permission for my child,________________________________to attend the United Parish Church Youth Group Apple Picking Field Trip on September 25th 2011. In the event of an emergency, I hereby give permission to the representatives of United Parish Church to act in my stead, giving consent to any hospitalization and/or medical treatment by a licensed physician or emergency team. I agree to be liable for any and all costs involved in such emergency medical treatment. I release and discharge the representatives of United Parish Church from any liability whatsoever in exercising permission for this activity.

X_________________________________________________________ __________________________ Parent or guardian signature Date