field trip authorization

No student will be permitted on the Field Trip unless this completed and signed Authorization is submitted to the Supervising Teacher, Sponsor, or Sch...

0 downloads 1 Views 256KB Size

Recommend Documents

Field Trip
Factivation is a great website to help your student work on multiplication. It is important for your children to memorize these facts. Login: ...

Overnight Field Trip Form
Teacher in Charge: Victoria Salo. Class/Group Attending: Alexandra Peterman from AP Biology class. Number of students attending trip: 1. Address and phone ...

Overnight Field Trip Form
Co-ed Overnight field trip, you must ensure that both genders are proportionally represented. (example-for every 8 female students, there will be 1 female ...

Field Trip Application
Requests for field trips must be received two weeks prior to the date of the requested trip. The field trip sponsor is expected to complete a written report ...

field trip request
Date of Trip__________________________________. # of Children/Teachers/Chaperones____________________. Busses ...

Field trip Contract 2018

Overnight Field Trip Form
Apr 13, 2018 - Teacher in Charge: Chris Ferrell ... Name of Chaperones: Chris Ferrell, Maine Music Educators Association Covers all ... Jared Bayley.

Overnight Field Trip Form
Class/Group Attending: Odyssey of the Mind- BHS structure team and possibly BMS structure team. Number of students attending trip: 6 or 12 depending on ...

Field Trip Request Form
m. p.m. (circle one). 9. Approximate time returning from this trip: a.m. p.m. (circle one). 10. Describe the education purpose of the field trip: 11. Have all student ...

Overnight Field Trip Form
Mar 17, 2018 - Teacher in Charge: Patrick Bolin. Class/Group Attending: BHS Jazz Ensemble and Jazz Combo 1. Number of students attending trip: 22.


STUDENT FIELD TRIP AUTHORIZATION No student will be permitted on the Field Trip unless this completed and signed Authorization is submitted to the Supervising Teacher, Sponsor, or School Main Office at least 48 hours prior to Field Trip. Verbal Authorizations, or Authorizations not on this form, cannot be accepted.

Student Name:

School: Home/Cell/Work Telephone: Parent/Guardian Name: (Best way to reach you during trip) Emergency Contact & Telephone No. (other than parent): Field Trip Destination: Field Trip Date:

Suggested Contribution:

Expected Departure Date/Time Expected Return Date/Time: Method of Transportation: Supervising Teacher/Sponsor: Physician’s Name: Physician’s Address & Phone: Medical Conditions/Medications: Medical or Patient ID Number: FOOD SERVICE: Is a sack lunch required for this activity? (Sponsor, please check)  Yes  No Parents: If a sack lunch is required (7 day notice) for this activity, they are available through Food Service or you may bring your own sack lunch.  Yes – I would like to order a sack lunch from the cafeteria (payment** must be attached to this permission form)  My student has a Peanut Allergy  No – I will send a sack lunch from home with my student (**Federal Lunch Program rules and procedures remain in place for sack lunch requests)

PRINCIPAL’S SIGNATURE: By signing below, I acknowledge and agree as follows: 1. Participation in this Field Trip is voluntary and is a privilege. I understand that the student has the right and ability to remain at school instead of participating in the Field Trip. I request that the Student be allowed to participate in the Field Trip, under the supervision of the Supervising Teacher/Sponsor and/or adult chaperones, with transportation to be provided in the described manner (which may include transportation in non-County Office of Education ("COE") owned/operated vehicles). 2. California Education Code Section 35330 states that: “All persons making the field trip or excursion shall be deemed to have waived all claims against the COE or the State of California for injury, accident, illness, or death occurring during or by reason of the field trip or excursion.” I understand and agree that I cannot hold the COE, its officers, agents, or employees liable for any claim arising out of, or which is in some manner connected with, the Student’s participation in this Field Trip. [Adults participating in out-of-state Field Trips must also sign a statement waiving such claims.] 3. The Supervising Teacher or Sponsor will discuss Field Trip rules and safety requirements with students and adult chaperones prior to the Field Trip, which may include dangerous or hazardous conditions or circumstances exposing the Student to potential harm or injury, potentially including death. Students are required to obey all rules and safety requirements of the Field Trip, as well as Codes of Conduct and general standards for respect of persons and property and good behavior. I understand and agree that failure of the Student to follow Field Trip rules or safety requirements may result in the Student being sent home, at my expense, and that the Student may be barred as a result from future Field Trips. 4. Emergency medical information regarding the Student is on file with the COE and is current. (Provide updated information before the trip, if necessary) If an injury or medical emergency occurs during the Field Trip, a Supervising Teacher, Sponsor or Chaperone has my express permission to administrator or to authorize the administration of urgent or emergency care, including the transportation of the Student to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. All costs and expenses associated with such care are solely my responsibility. 5. The suggested contribution is the COE’s estimated cost for your student to participate in this field trip. No student will be excluded from the field trip due to an inability to contribute toward such costs. Please contact the supervising teacher or the school office for more information. Contributions may be received by the supervising teacher or the school office.

Parent/Guardian Printed Name Date Received by School:


Date Received by:

Supervising Teacher/Sponsor shall take a copy of this form on the Field Trip/The original Form will remain on File with the Main Office for a period of no less than one (1) year after the date of the Field Trip

Life Enjoy

" Life is not a problem to be solved but a reality to be experienced! "

Get in touch


© Copyright 2013 - 2019 DOKUMENTIX.COM - All rights reserved.