Enrichment Activity – Offsite Permission Form

Activity:  Field Trip to Alpha & Omega

Description:  Our K – 9th grade students will be going to Alpha & Omega Corn Maze

Location: 129 Cheek Rd, Hamptonville, NC 27020

Date: Nov 9th, 2022

Time: 8:45am – 2pm

Cost:  Free

A few more details:

We will be leaving between 8:45am and 9am.  Anyone arriving for school after 8:30am will need to make other arrangements for the entire school day.  We will be returning to school by 2pm for dismissal.

Students need to wear closed toed shoes and dress appropriately for being outside all day.

If you are packing their lunch for this trip, please pack in a paper or plastic bag with their name on it and make sure that all items are able to be thrown away, including a water bottle.  For those that have paid for lunch, water will be provided.  If you would like to opt in for a school lunch that day, please let us know by Monday, Nov 7th and send in $3 with your child.

Headwaters Permission Form

  • I give permission for my child to take part in this activity.
  • I am fully aware that my child will be transported to and from this activity and that there will be ample supervision. I have previously completed a Medical/Liability Release Form for my child. By signing this permission slip, I am confirming that the information on his/her Medical/Liability Release Form is current and up to date. I understand in the unlikely event of an accident or emergency that my child will receive adequate care based upon the information given. I assume all risks, hazards and incidentals involved in the conduct of the activity. I do hereby release, indemnify and hold harmless Headwaters Educational Enrichment and South River Baptist Church from any and all loss, injury or other damage arising out of this activity. I understand that the child will be transported to and from the offiste activity and I also understand the inherent risks in any travel, and agree to waive any and all liability on behalf of the referenced organizations for those risks.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.