Johnny Wilson Farm

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In-Person Payment

Select this option if you will send cash or a check to the school with your student

By selecting this option, I understand that:

A 25 dollar fee applies to returned checks
My student’s spot is not secured until payment has been received and cleared by the school
I am still required to complete the online permission form

Pay In Person

$19.00

*Participant's First Name

*Participant's Last Name

*Teacher's Name (or 1st period teacher)

*Current Grade

*Emergency contact #1

List name, and relationship. Must be over 21 years old.

*Parent/Guardian First & Last Name

*Emergency contact #1 phone number

*Emergency contact #2

List name, and relationship. Must be over 21 years old.

*Emergency contact #2 phone number

*Has your student's emergency or medical information changed since the beginning of the school year?

Yes

If yes, please explain what changed

*I confirm that I am the parent or legal guardian of the student listed above and give my permission for my student to attend the field trip described in this form.

I agree

*I permit my student to be photographed, videotaped, or otherwise recorded during this field trip for educational and school-related publications, social media, or promotional purposes.

Yes