University Of Southern Maine-SB-UB-Boston Permission Slip 2

	Wednesday, May 24
8:00 a.m.	Meet at Saco Train Station- 138 Maine Street, Saco, ME
8:20 a.m.	Train Departs for Boston
10:30 a.m.	Train Arrives in North Station Boston
11:00 a.m.	Lunch at Quincy Market
12:00 p.m.	Walking tour of Emerson College
1:30 p.m.	Arrive at New England Aquarium
4:00 p.m.	Leave for North Station
5:20 p.m.	Train Departs North Station
7:25 p.m.	Train arrives at Saco Station for Student Pickup

Things to know:

Trip Details: This permission slip needs to be submitted by 8:00 a.m. on Thursday, May 18. Advisors will let students know when their spot has been confirmed.

Meals: Students will be provided lunch. Students are welcome to bring personal money for snacks on the train.

Upward Bound Cell Phone:

Should you need to contact the staff chaperones or your student during the trip please call Joe at 630-453-0747 or Sam Prosser at 774-364-4236

All trip costs are covered by Upward Bound.
Student Full Name:*

First NameLast Name
Student Email:*
example@example.com
Student Cell Phone Number
(999)999-9999
I give permission for {main_name} to attend the TRIO Upward Bound at USM event as decribed above. UB participants will be transported by Amtrak train to and from Boston's North Station. Students are responsible for transportation to and from Saco train station.
I, (parent/guardian)*

First NameLast Name
give permission for non-licensed trained Upward Bound personnel to assist my student in taking the following medication while participation in Upward Bound activities:

Medication Name/Dose/Notes:

	Name	Dose	Notes
1
2

EPI-PEN: Student MAY or MAY NOT (select one) self-carry and administer or N/A:*

MAYMAY NOTN/A
INHALER: Student MAY or MAY NOT (select one) self-carry and administer or N/A:*

MAYMAY NOTN/A
*We will be following the summer program protocol for medication: Pleae make sure all medication is in its original packaging with a prescription label and/or student's name*
Parent/Guardian printed name:*

First NameLast Name
Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy
Parent Email*
example@example.com
Best phone number to reach you:*
(999)999-9999

TRIO Upward Bound at University of Southern Maine