Fillable Student Permission Form For Field Trip printable pdf download

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Risk Management

Student Permission Form for Field Trip

2407 LaPorte Ave

Fort Collins CO 80521

(One Day or Less)

970.490.3506

Note to Parent/Guardian: In order for your child to participate in this field trip, you must complete Emergency Contact

and Permission section on Page 2 of this form and return the completed form by:

School:

Field Trip to:

Date of Field Trip:

Departure Time:

Return Time:

Will this field trip occur outside of normal school hours?

Yes

Grade:

Estimated # of Students:

Activities Involved:

Transportation:

Private Vehicle*

PSD Bus

Parent/Guardian Responsibility

Walking

Public Transportation

Other:

* Select all that apply from the following:

PSD Employee

PSD Parent Volunteer

PSD Student

Each driver must complete the required form(s) and be approved by the building principal.

*Name of Driver:

Special Instructions (e.g., items students should bring):

Special Procedures and Considerations

necessary

Your child’s participation in the field trip is voluntary. Your written consent on the second page of this form is

for your child to participate.

•

The School District is protected from liability under the Colorado

Field trips may potentially involve risks and

•

Governmental Immunity Act for injuries and damages that may arise

responsibilities for your child that are beyond the

out of or in connection with the field trip, and any injuries or

scope of those normally associated with educational

damages arising out of or in connection with the field trip may

activities at school. Such risks include the potential

therefore not be covered by School District insurance. For these

for personal injury and/or damage to personal

reasons, it is recommended that you obtain appropriate insurance

property. You are encouraged to inquire in advance

from qualified sources to cover medical expenses and other costs

concerning the nature, details, and potential risks of

that could result from injury to your child, and damage to or

this field trip.

destruction of property belonging to you or your child, which may

arise out of or in connection with your child’s participation in the field

•

Your child shall be subject to the Poudre School

trip. The School District has information available regarding

District Code of Conduct at all times related to his/

accident and health insurance that may be purchased to cover

her participation in the field trip. As a condition of

your child’s participation in the field trip. You may enroll at

participating in the field trip, your child shall also be

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required to comply with all instructions and safety

obtain a brochure through the school office.

precautions communicated by school officials.

Principal Review:

Approved

# of Adult Chaperones Required:

Denied

Special qualification required of chaperones OR reason(s) for denial:

Principal’s Signature:

Date:

Page 1: For Parent to Keep

August 2015

Student Permission Form For Field Trip

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