Frederick Public Schools Travel Consent form for students

Due to insurance problems, malpractice suits, etc., doctors or hospitals will not normally

administer aid to an injured person without a parent/guardian present or the consent of

the same. To alleviate this problem, we would like you to sign the consent from below. A copy of this form will accompany all Frederick School students to all events. I,

____________________________________________, do give my permission for the

following school personnel to obtain medical attention for my son or daughter,

____________________________________________, if needed.

Administrators:	Coaches:	Spanish Club:
O’Brien, Tony, Superintendent	Converse, Brett	Mitchell, Pat
Hoover, Ruth Ann, Principal	Farmer, Hugh
Parsons, Michael, Asst Prin.	Humble, Matt	Special Education :
Biggs, Randy, Principal	McBee, Ashley	Allee, Phyllis
Baxter, Nancy, Asst.Prin.	Morris, Wayne	Crume, Janis
Read, Joel, Principal	Patterson, Brad	Stevens, Tracey
Abbott, Kimberly, Asst Prin	Roady, Charles	Switch, Gabby
	Smith, Miles
Academic Team:	Stehr, Heath
Archer, Angela	Switch, Michael	Student Council:
		Franklin, Starla
Cheerleading:		Howard, Wendy
Hazle, Melanie	F.F.A.:
Nolan, Classie	Blankenship, Bill	Talented & Gifted:
		Cassidy, Kim
Color Guard:	GEAR UP:	Hagy, Debra
Osterhout, Peg	Cassidy, Kim
Counselor Norvell, Dana	Music Teachers:	Interact :
	Clayton, Ann	Melanie Hazle
	Schreiner, Carisa

Any allergies or conditions? _______________________________________________________________________

_______________________________________________

Signature of parent or guardian

Home phone number ______________________Cell Phone # ____________________

Emergency Phone #___________ Address:____________________________________