CLEAR FORM
Student’s Name _________________________________ Teacher _________________________________
Portland Public Schools
Parent/Guardian Permission for Student Travel Within the United States
STANDARD DAY FIELD TRIPS
RELEASE OF LIABILITY AND HOLD HARMLESS
Permission is granted for my child to participate in the following trip activities knowing that for each trip,
students will be leaving and returning to school on the same day. These trips will take place within the same
month and are NOT considered activities of a wilderness nature.
School: _________________________________________
Trip 1 - Date:
Department/Class:
Trip Leader:
Destination:
Activity:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Other:__________________________________________________________________________________________
Mode of Travel:
Private Vehicle
District Vehicle
Non-District Public Transportation (Common Carrier)
Trip 2 - Date:
Department/Class:
Trip Leader:
Destination:
Activity:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Other:__________________________________________________________________________________________
_____________________________________________________________________________________________
Mode of Travel:
Private Vehicle
District Vehicle
Non-District Public Transportation (Common Carrier)
Trip 3 - Date:
Department/Class:
Trip Leader:
Destination:
Activity:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Other:__________________________________________________________________________________________
_____________________________________________________________________________________________
Mode of Travel:
Private Vehicle
District Vehicle
Non-District Public Transportation (Common Carrier)
Trip 4 - Date:
Department/Class:
Trip Leader:
Destination:
Activity:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Other:__________________________________________________________________________________________
_____________________________________________________________________________________________
Mode of Travel:
Private Vehicle
District Vehicle
Non-District Public Transportation (Common Carrier)
Please turn over and sign on page 2
page 1 of 2
Next Page