Field Trip Permission Form - Boulder Valley School District
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1School ____________________
PLEASE RETURN THIS FORM BY:
______________
Destination ___________________
Date(s) of trip activity ____________________
Teacher ____________________
BOULDER VALLEY SCHOOL DISTRICT
STUDENT TRAVEL
FIELD TRIP PERMISSION FORM
I hereby permit ________________________________________________________________ to participate in
__________________________________________________________________________________________
(Describe trip/activity)
(Dates(s))
He/She will be transported by:
Fee required _____________
School Bus __________________
*Sack Lunch (see below)
Private car __________________
Walking __________________
Transportation if the responsibility
of the parent _______________
Other ______________________
(Specify)
1. I understand that the Field Trip/Activity may take place away form school property; may involve
transportation by school bus, private vehicle, common caries or other mode of transportation; and may
involve activities beyond the scope of traditional school functions conducted on School district property.
2. I understand that the Field Trip/Activity may involve activities beyond the scope of traditional school
functions. I acknowledge that my student’s participation in the activities potentially involves risks and
obligations that are impossible to predict, by may include the risk of loss or damage to personal property
and the risk of sickness, personal injury or death.
3. I understand that the School District does not purchase, or have, any medical, dental or hospitalization
insurance to cover injuries to or loss of life of students or to indemnify parents and guardians for
expenses in connection therewith, and that such insurance, if desired, must be purchased by me.
_____________________________
_____________________________________________________
Date
Signature of Parent or Guardian
TO BE USED FOR LOCAL AND METRO AREA SHORT TRIPS. THIS FORM IS TO BE COMPLETED BY STAFF AND
.
SUBMITTED TO PARENT/GUARDIAN FOR SIGNATURE
*If you would like the school to make a sack lunch for your child, fill out the form below and return this
signed permission slip to the classroom teacher. Your child’s lunch account will be charged the price they
normally pay for school lunches.
--------------------------------------------Teacher: Tear off and take to Kitchen.---------------------------------------------
Yes, make a sack lunch for:
Child’s Name ________________________ Teacher _________________________ Date of Trip _________
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