2. Statement of Acknowledgment and Consent to Conditions of Trip (Adult not an employee of or student in the San Diego Unified School District)

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Office of the Superintendent FIELD TRIP PLANNING PACKET SINGLE DAY District Procedure No Contents of packet 1. Site-Approval Checklist for Single-Day Field Trips 2. Statement of Acknowledgment and
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Office of the Superintendent FIELD TRIP PLANNING PACKET SINGLE DAY District Procedure No Contents of packet 1. Site-Approval Checklist for Single-Day Field Trips 2. Statement of Acknowledgment and Consent to Conditions of Trip (Adult not an employee of or student in the San Diego Unified School District) 3. Statement of Acknowledgment and Consent to Conditions of Trip (Employee of the San Diego Unified School District) 4. Field Trip Conflict of Interest Disclosure Form 5. School must also keep on file a copy of the parent permission form that was sent home. 6. Volunteer Code of Conduct 7. School Volunteer Application (3 part NCR form) for additional forms contact Community Relations Department Related Procedures Approved carriers, instructions, and rates/ordering transportation No Community Concourse tours No Employee liability No Field trips, domestic (multi-day) and foreign (single & multi-day) No Fundraising No and No School Volunteer Programs No. 4595 Office of the Superintendent SITE APPROVAL CHECKLIST FOR SINGLE-DAY FIELD TRIPS School: Dates of Trip: Trip Destination: Approval of Site Administrator: (Signature) (Date) To be completed by certificated staff member in charge of the field trip. Date Completed Initials AT LEAST EIGHT WEEKS PRIOR TO TRIP (THREE MONTHS or more if fundraising is involved) 1. Secure principal's tentative approval to conduct field trip (and approval to conduct fundraising, if applicable). 2. Contact place(s) being visited to make preliminary arrangements, as needed. 3. Review procedure for fund-raising and develop a plan including fund-raising activities, a plan for assisting students who are unable to pay their own expenses, and a method for return of funds if not used for the trip. AT LEAST SIX WEEKS PRIOR TO TRIP 4. As far in advance as possible, arrange preliminary trip booking (Procedure No. 4586). 5. Obtain Field Trip Order/Report Form (T-Form) from secretary or principal's designee; complete according to instructions on form and in Procedure No. 4586; submit to secretary or principal's designee for final scheduling and processing. FOUR WEEKS PRIOR TO TRIP 6. If substitute is required, complete Request for Absence on District Business, and submit to principal for approval. TWO WEEKS PRIOR TO TRIP 7. Place meal order count with school cafeteria. ONE TO TWO WEEKS PRIOR TO TRIP 8. If academic competition is involved, submit to principal for approval: a) Written criteria and guidelines used to select participants in academic competitions, and b) Copies of written communications used to inform parents and students of the academic competition and of the governing guidelines. 9. Send home request for parental approval of student participation. If parent does not sign student cannot go. Phone approval is not acceptable. 10. Verify that attempts were made to recruit students from all ethnic groups to participate. 11. Make final arrangements with place(s) to be visited. 12. Secure certificated supervisors for trip. 13. Provide written statements verifying that instructors and voluntary supervisors will contribute their time without pay or reimbursement during the trip and will waive all claims against the district by securing their signatures on appropriate forms. File waivers in school office. 14. Secure parent chaperones, if appropriate. Provide Volunteer Forms to principal and secure his/her approval. 15. Verify that permission forms and waivers are returned for all students participating in field trip. Verify alternate arrangements at school for those students not participating. 16. Arrange for participating students to be excused from the classes. Notify Cafeteria number of students going on field trip. PRIOR TO DEPARTURE 17. Instruct students on safety prior to trip. 18. Arrange for first-aid kit and/or snake-bite kit, and ensure they are taken on trip. 19. If private vehicles are to be used, provide required instruction for their use and ensure that safety checks are done. (See District Procedure No. 4586) 20. Report to secretary or principal's designee the names of all persons (adults and students) who will actually go on the trip. Provide list of students to verify those actually participating prior to departure. 21. TO CANCEL TRIP: To avoid cancellation charges, notify secretary or principal's designee of cancellation at least 48 hours in advance of trip so Transportation Services Department can be notified to cancel bus service. 22. If circumstances change before the trip, notify secretary or principal's designee of any changes that must be coordinated with carrier, such as change in pickup time, number of passengers, etc. (Carrier may not accept major changes in trip details unless there is prior coordination/notification of at least three (3) workdays.) 23. Leave a copy of the participation roster in the school office. UPON COMPLETION OF FIELD TRIP 24. Teacher completes section C on T-Form according to directions on form, signs form and submits to secretary or principal's designee. Notifies secretary or principal's designee of any changes that might be required on form. 25. If appropriate, teacher conducts evaluation of field trip and shares with principal. 26. Files this form with other required papers in school office. (Records must be kept for three years.) Office of the Superintendent STATEMENT OF ACKNOWLEDGMENT AND CONSENT TO CONDITIONS OF TRIP (Adult, not an Employee or Student in the District) I,, am the (name of adult) (indicate relationship to student, e.g., parent or other relative) of, a student enrolled at (name of student) (name of school) a public school operated by the San Diego Unified School District. I understand that a group identified as (describe group) enrolled at the following schools(s): has been offered the opportunity to participate in a field trip to, and that I have been asked to accompany these students on their trip during the period from to. I understand that my participation in the aforementioned program, including the field trip, is voluntary. I agree to pay all expenses for my participation in the field trip including, but not limited to, the cost of airfare and such insurance as may be required by the San Diego Unified School District. I am aware of the provisions of Education Code Section 35330, which states in part that All persons making the field trip or excursion shall be deemed to have waived all claims against the district or the State of California for injury, accident, illness, or death occurring during, or by reason of, the field trip or excursion I have read and understand the foregoing statement and sign it below voluntarily. Executed in the City of San Diego, County of San Diego, State of California, on. (date and year) (Signature) (Print or Type Name) Office of the Superintendent STATEMENT OF ACKNOWLEDGMENT AND CONSENT TO CONDITIONS OF TRIP (Employee of the San Diego Unified School District) I,, am an Employee of the San Diego Unified School District, (name of employee) assigned to, a public school operated by (name of school) the San Diego Unified School District. I understand that a group identified as (describe group) enrolled at the following schools(s): will participate in a field trip to, and that I have been asked to accompany these students on their trip during the period from to. Except as may have been agreed between my supervisor and me, or as may be set forth in documents governing my terms and conditions of employment, I agree to pay all expenses for my participation in the field trip, including but not limited to, the cost of airfare. I further agree to donate as much of my time beyond my normal workday as may be required while on the field trip. I understand that I will suffer no loss of pay by reason of participating in the field trip. I further understand that, except as set forth above, I will receive no additional compensation for any such time or services donated by me, or for any other reason, in connection with the trip. I am aware of the provisions of Education Code Section 35330, which states in part that All persons making the field trip or excursion shall be deemed to have waived all claims against the district or the State of California for injury, accident, illness, or death occurring during, or by reason of, the field trip or excursion My acknowledgment of the foregoing paragraph is subject to the proviso that I retain any and all of my employment rights including, but not limited to, district liability insurance, workers compensation insurance, and district health insurance. I have read and understand the foregoing statement and sign it below voluntarily. Executed in the City of San Diego, County of San Diego, State of California, on. (date and year) (Signature) (Print or Type Name) Office of the Superintendent CONFLICT OF INTEREST DISCLOSURE FORM Each principal, ASB advisor or teacher sponsoring or participating in a tour or trip paid by students is required to complete this form. Field Trip and Date Name Position Location Indicate below whether you or a member of your family is currently receiving (or has received during the last five years) any gratuity, commission, rebate, or thing of value from any travel agency or travel promoter. Plane fares, hotel accommodations, etc., provided in return for chaperoning should be listed and would be considered reasonable and acceptable. Self Relative Company Name Year of Gratuity Type of Gratuity Value of Gratuity (Signature) (Date) AUTHORIZATION FOR STUDENT PARTICIPATION ONE-DAY OR SEASONAL ACTIVITY wishes to participate in (Student s name) (Activity) on from p.m. to p.m. or (Date) during from to. (Semester or Season) (Date) (Date) Transportation will be by (Chartered bus, private car driven by school employees, parents, or students) It is necessary that the parents specifically authorize that their child be included in the activity. Supervision for this event will be furnished by the school, but parents should understand that supervision will end at the time slated above. The school will take every precaution to assure the welfare and safety of your son/daughter participating in this activity. However, it is important that you understand that the school cannot assume financial or legal liability in case of injury or accident. Low cost student accident insurance is available; also, additional low cost insurance is available for students participating in interscholastic athletics. Please call or write the school office for information. Cold sack lunches are available from the school cafeteria. Students who qualify may receive meals free or at reduced price. If you wish your son/daughter to participate in the above described activity, please complete the request for participation form below, and return it to the school immediately. Activity Sponsor Principal (Tear on dotted line and return lower portion.) PARENT AUTHORIZATION FOR PARTICIPATION I, the undersigned, authorize my son/daughter (Name of student) to participate in (Name of activity) scheduled for from p.m. to p.m., or (Semester) (Date) (Date) during from to. (Semester or Season) (Date) (Date) California law (Education Code Section 35330) provides that any person making a field trip or excursion waives all claims against the school district and the State of California for injury, accident, illness, or death occurring during or by reason of the field trip or excursion. Date Signed Signatures of Parent(s) or Guardian(s) DISTRITO ESCOLAR UNIFICADO DE SAN DIEGO AUTORIZACIÓN PARA LA PARTICIPACIÓN DEL ESTUDIANTE EN UNA ACTIVIDAD DE TEMPORADA O DE UN DÍA desea participar en (Nombre del estudiante) (Nombre de la actividad) del de las p.m. a las p.m. (Fecha) o durante del a. (Semestre o Temporada) (Fecha) (Fecha) El medio de transportación será por (Autobús alquilado, automóvil particular manejado por algún empleado escolar, padre de familia o estudiante.) Es necesario que los padres de familia o tutores específicamente autoricen la inclusión de su hijo/a en esta actividad. La escuela supervisará este evento pero deben estar enterados los padres que dicha supervisión terminará en la fecha y hora indicada. La escuela tomará las precauciones necesarias para garantizar el bienestar y la seguridad de su hijo/a durante esta actividad. Sin embargo, es muy importante aclarar que la escuela no tendrá responsabilidad legal o financiera en caso de lesiones o accidentes. Si los padres desean pagar por un seguro escolar económico que cubre accidentes, está a su disposición, lo mismo que un seguro económico para los estudiantes que participan en deportes interescolares. Favor de llamar o escribir a la oficina de la escuela si desea información. Los alumnos pueden comprar cajitas con almuerzos en la cafetería. Los alumnos elegibles podrán recibir almuerzo gratuito o a precio reducido. Si desea que su hijo/a participe en la actividad descrita arriba, llene la solicitud de participación de abajo y envíela a la escuela inmediatamente. Patrocinador de la actividad Director AUTORIZACIÓN FAMILIAR PARA PARTICIPACIÓN DEL ESTUDIANTE EN UNA ACTIVIDAD ESCOLAR Por este medio autorizo que mi hijo/hija participe (Nombre del estudiante) En (Descripción de la actividad) programada para de las p.m. a las p.m., (Semestre) (Fecha) (Fecha) o durante de a. (Semestre o Temporada) (Fecha) (Fecha) La ley de California estipula (Código de Educación 35330) que cualquier persona que participe en un viaje de estudios o excursión se desista de todas las demandas o quejas en contra el distrito escolar o el estado de California como consecuencia de cualquier lesión, accidente, enfermedad o muerte que pudiera ocurrir durante o por la actividad. Fecha de la firma(s) Firma(s) del padre(s) de familia o tutor(s) San Diego Unified School District Community Relations Department VOLUNTEER CODE OF CONDUCT (This document defines the district s expectations for all school volunteers.) As a volunteer, I agree to abide by the following code of volunteer conduct: 1. Immediately upon arrival, I will sign in at the main office or the designated sign-in station. 2. I will wear or show volunteer identification whenever required by the school to do so. 3. I will use only adult bathroom facilities. 4. I agree to never be alone with individual students who are not under the supervision of teachers or school authorities. 5. I will not contact students outside of school hours without permission from the students parents. 6. I agree not to exchange telephone numbers, home addresses, addresses or any other home directory information with students for any purpose unless it is required as part of my role as a volunteer. I will exchange home directory information only with parental and administrative approval. 7. I will maintain confidentiality outside of school and will share with teachers and/or school administrators any concerns that I may have related to student welfare and/or safety. 8. I agree to not transport students without the written permission of parents or guardians or without the expressed permission of the school or district and will abide by District Administrative Procedure # 4586 when transporting students. 9. I will not disclose, use, or disseminate student photographs or personal information about students, self, or others. 10. I agree only to do what is in the best personal and educational interest of every child with whom I come into contact. I agree to follow the Volunteer Code of Conduct at all times or cease volunteering immediately. November 2006
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