Incarnate Word Academy
Catholic High School for Young Women Since 1873
Field Trip Permission
Destination: Field Trips within Downtown Houston during the 2021-2022 school year.
Method of Transportation:Walk under the supervision of Incarnate Word Academy faculty and/or staff.
Date: 2021-2022 School Year
Instructions to Students:
By signing this form, I/we__________________________________certify that I/we request and give permission
(Parent or Guardian)
for____________________________________to go to on this Field Trip.
I/we have given the instructions required above, and I/we release and save harmless Incarnate Word Academy
and any and all of its employees from any and all liability for any and all harm arising to my/our daughter as a
result of this trip, and waive any claims against them.
(Signature of Parent or Guardian)
Emergency Information
_____________________________________ _________________ ________________________
Parent/Guardian Name Phone Medical Ins. Carrier
_____________________________________ _________________ ________________________
Doctor’s Name Phone Policy #
_____________________________________ _________________
Preferred Hospital Phone
I/we give permission for ____________________________________________to be transported by ambulance
and/or to be treated in the event of a medical emergency.
(Signature of Parent or Guardian)
609 Crawford Street
Houston, TX 77002
Phone 713-227-3637
Fax 713-227-1014