Field Trip Request Form (Page 2 of 2) in pdf

Field Trips & Excursions

Certificate of Insurance Coverage

NOTE: This portion must be completed if privately owned vehicle will be used for Field Trips & Excursions.

I, _____________________ , an employee of Tazewell County Schools at ___________________, am aware of

Regulation EEA-R concerning the use of private cars for transporting students. On my vehicle, I carry the

minimum limits of insurance as follows:

$300,000 / $500,000 - Bodily Injury

$50,000 - Property Damage

$5,000 - Medical Payments

I understand that my insurance will be primary in the case of an accident for all occupants of my vehicle, and that

Tazewell County Schools’ coverage will be secondary.

________________________________________

Signature of Employee

Signature of Principal

CHECKLIST FOR TEACHERS, SPONSORS, AND PRINCIPALS:

(This checklist is not inclusive, but a guide for the principal.)

The principal is responsible for the safety of both staff and students during all aspects of field trip travel.

Adequate planning, liability, consideration, and financing must be addressed for successful educational

1. Does the scheduling of the field trip enhance the objectives of the class or course?

2. Has the purpose of the field trip and its benefits been discussed with the students?

3. Has the field trip been cross-checked with the school activity calendar?

4. Does the trip minimize absence from school?

5. Has the closest and best location been considered?

6. Has a contact person been identified at the site and their participation confirmed?

7. Have chaperones been made aware of security needs at stops to guard against placing children

in unsafe situations?

8. Do chaperones have a contact number for school personnel in case of emergency?

9. Have contingency plans been developed for emergency situations?

10. Have the financial arrangements been worked out for all students?

11. Have parental and student forms been distributed, completed, and collected?

•

Permission forms and emergency care completed and returned

•

Written guidelines of trip rules distributed, discussed, and signed by the parents and students

•

Consideration given for parents to sign a luggage consent form so that school personnel can

search belongings for illegal or prohibited items if necessary. Parents of any student possessing, selling

or using illegal drugs/alcohol will be notified by a designated chaperone to make arrangements to come for

the student and transport him/her home. (See Policy JFCI-R)

Code of Virginia, Section 22.1-176, 22.1-182, 22.1-190 Virginia High School League –

Chaperones:

____________________________________

Field Trip Request Form Page 2