Police & Campus Safety Student Agreement and Medical Release Form for Classroom Related Travel

Please complete required fields on the form and attach the field trip authorization packet. If your attachment is greater than 30 MB, please split the file or send it directly to Stephanie Bolechowski at sbolechowski@mtsac.edu. Thank you!

General Field Trip Information

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Type of Transportation*

Emergency Contact Informaton

Please provide the name of individual that will be contacted in case of an emergency.

Required Documents

Please submit the following forms: 1. Field Trip Authorization and/or Transportation Request 2. Student Agreement and Medical Release for Classroom-Related Travel

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