Indiana Math and Science Academy-South

Field Trip to Hilbert Circle Theatre

45 Monument Circle, Indianapolis, IN 46204
We will be taking 6th, 7th, and 8th grade students who have earned As and Bs
in all their classes to see the Indianapolis Symphony Orchestra perform on
October 29, 2015 at 11am. Grades checked 9/22/15.
**Signed permission slip due by Wednesday, September 30, 2015. **
Supervisor(s): Miss Fegett
Date: Thursday, October 29, 2015
Leaving school: 10:00am
Returning: Approximately 1:00 pm (Sack Lunches Provided)
Transportation: Bus

Cost: FREE!! (Thank you for your hard work and commitment to
learning!)
Missed Work:
Students need to communicate with their 3rd-7th period teachers ahead of time to get
the work they will need to make up and turn in the following day (Friday).

Dress Code:
We will be representing all IMSA schools and will need to wear proper concert attire.
Students will be allowed to wear proper concert attire for the entire school day.
Concert attire should adhere to dress code regulations:
No tank tops/spaghetti straps. Shoulders must be covered by short sleeves
or longer.
Solid color socks/hose and dress shoes.
Skirts/Dresses must extend below the knee.
Ladies may bring a small purse.
Proper concert attire DOES NOT include the following:
Jeans
Shorts
T-Shirts
Sweatshirts/Hoodies
It is recommended that ladies wear a skirt, dress, or dress pants with a nice top.
Gentlemen wear khakis or dress pants with a polo or dress shirt.

Students not wearing proper attire will not be allowed to go on the trip. If you have
any doubts/questions please ask Miss Fegett beforehand.
WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in program and related events and activities, the undersigned:
1.
2.

3.
4.

Agree that the parent (s) or legal guardian(s) will instruct the minor participant that prior to participating, s/he should inspect the
facilities and equipment to be used, and if the participant believes anything is unsafe, s/he should immediately advise his/her or
supervisor of such condition(s) and refuse to participate.
Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including
permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or
negligence, but the actions, inactions or negligence of others, the rules of play or the condition of the premises or of any equipment used.
Further, that there may be other risks not known or not reasonably foreseeable at this time.
Assume all the foregoing risks and accept personal responsibility for damages following such injury, permanent disability or death.
Release, waive, discharge and covenant not to sue Indiana Math and Science Academy, Teachers, Directors and other employees and
volunteers of the organization, other participants, and, if applicable, owners and lessees of premises used to conduct the event, all of
which are hereinafter referred to as release, from any and all liability to each of the undersigned, his or her heirs and next of kin for
any claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to caused in
whole or in part by the negligence of the release or otherwise.

I/ WE, THE UNDERSIGNED, HAVE READ THE ABOVE WAIVER& RELEASE, UNDERSTAND
THAT I/ WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT
VOLUNTARILY.
PARENT/ GUARDIAN SIGNATURE: ____________________________________________RELATION:
____________________
PARENT/ GUARDIAN PRINTED NAME:
_______________________________________DATE:__________________________
TELEPHONE NUMBER: __________________________________________
STUDENT SIGNATURE:
_________________________________________________________DATE:____________________
______
STUDENT PRINTED NAME: _____________________________________________________
**Emergency Contact other than
parent/guardian______________________________________________________________
Phone:____________________________________________
CHECK ONE:
I will be needing a sack lunch on Thursday, October 29th: _________________
I will be bringing my lunch from home on Thursday, October 29th:
_______________________