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Ohio Department of Job and Family Services

FIELD TRIP PERMISSION FOR CHILD CARE

Field Trip Information

Date of trip

Field trip destination and address

Approximate time of departure

Approximate time of return

Mode of transportation (walking, school bus, public transportation, parent vehicles, provider vehicle and driver)

During this field trip children will have access to water that is 18 inches or more in depth

YesNo(If yes, a swimming permission slip is required)

Water activities are planned

YesNo(If yes, a swimming permission slip is required)

Child's Information

Child's name

My child is

not over 4 years and/or 40 lbsover 4 years and 40 lbs8 years and/or over 4' 9"

Signature

I grant permission for my child to attend the field trip described above.

Parent's signature

Date

JFS 01226 (Rev. 12/2016)