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Affidavit Form

Nazareth Area School District                 One Education Plaza                Nazareth, PA 18064-2397                  610-759-1170


State of Pennsylvania    )

County of Northampton  )

Before me, the undersigned notary public, this day, personally appeared

____________________________________________, who being dully sworn according to law, deposes and says that:

                (Name of Parent/ Guardian)

Law, deposes and says that:


______________________________________ is the son/daughter of ______________________________


And is ____________________________ grade student at ___________________________ School,


Residing at ____________________________________________________________________________________.


They will be traveling to  ____________________________________________________________,


Which will necessitate ________________________________________ days of absence from school


Beginning _________________________________ and extending through _________________________________.

                                (First day of travel)                                                                      (Last day of travel)

The purpose of the intended trip and the involved travel will be a positive, educational experience for said child.

My signature below indicates that I have received and fully understand the expectations and my responsibilities and those of my child under Policy #204.1. A copy of the affidavit, sworn to by a notary or magistrate, must be returned to the building office ten (10) days prior to the students absence from school resulting from family education trip. Any days taken beyond the maximum days permitted for education trips in a given year may be considered unexcused and unlawful for students under the age of seventeen (17) and unexcused for students 17 years of age and over. Appropriate legal action may be taken where applicable. Permission will not be granted for trips/tours during the state’s standardized testing periods, and the secondary school examination periods and the end of the first and second trimesters. If trips are taken, the days will be considered unlawful/unexcused.


                                                                                                                 (Your signature)

Sworn to and subscribed before me,

This ____________ day of ___________________, 20_____.


(Notary Public)