Educational Excursions Information/Forms

EDUCATIONAL EXCURSION PERMISSION FORM 

(IN-COUNTY / OUT-OF-COUNTY TRIPS) 

 

 

DATE: _______/_______/_________

 

 

Dear Parent/s or Guardian:

 

On ______/______/________ our class will be taking a field trip to _________________________________________. We plan to leave school at approximately ________________ and return to school at approximately ______________. We would like your child to accompany us on this

trip. Please sign the permission slip below and return it no later than ______/______/________.

 

 

Lunch: will be provided. will not be provided.

 

 

Chaperones: are needed. are not needed.

 

___________________________________

 Teacher Signature

 

 

 

PLEASE SIGN AND RETURN THE PERMISSION FORM BELOW

 

 

 

EDUCATIONAL EXCURSION HOME PERMISSION FORM

 

 

 

Dear ________________________ (Teacher’s Name),

 

___________________________________________ (Child’s Name) has my permission to go to ___________________________________ with his/her class on _______________. I understand that all reasonable precautions have been and will be taken for the safety of my child. I further agree to hold harmless Hickory Public Schools, its agents, servants, and employees against any and all liability, loss, damages, costs or expenses which the above named child or I may sustain or incur as a result of any act or inaction of any agents, servants, or employees of the Hickory Public Schools School Board.

 

_______________________________________

 Parent or Guardian Signature

 

CHECK ONE:

 

__I would like for the school to provide my child with a bag lunch at the cost of his regular daily lunch.

 

 

 

__I choose to provide a bag lunch for my child.


 

EXTENDED/OVERNIGHT EXCURSION PERMISSION FORM 

 

 

DATE: _______/_______/_________

 

 

Dear Parent/s or Guardian:

 

On ______/______/________ our class will be taking a field trip to______________________________________________________. We plan to leave on ______/______/________ and return on ______/______/________. We would like your child to experience this learning opportunity.

 

Please sign the permission form attached no later than _______/________/__________.

 

A trip itinerary is included.

 

 

 

PLEASE SIGN AND RETURN THE PERMISSION FORM BELOW

 

 

 

 

 

EXTENDED/OVERNIGHT EXCURSION HOME PERMISSION FORM

 

Dear _______________________ (Teacher’s Name):

 

 

 

_____________________________________________________ (Student’s Name) has my

permission to go to______________________________________________________ with

his/her class on _______/________/__________. I understand that all reasonable precautions have been and will be taken for the safety of my child. I further agree to hold harmless the Hickory Public Schools, its agents, servants, and employees against any and all liability, loss, damages, costs, or expenses which the above-named child or I may sustain or incur as a result of any act or inaction of any agents, servants, or employees of the Hickory Public Schools’ School Board.

 

 

 

_______________________________________

Parent or Guardian Signature

 


 

Overnight Excursion Procedures 

 

I. Important documents that must be completed by the school and submitted to Central Office before participating in an overnight excursion:

 

Request(s) for overnight excursions will be forwarded to the Assistant Superintendent of Curriculum and Instruction. Overnight field trips must be approved by the Assistant Superintendent of Curriculum and Instruction at least four (4) weeks prior to the date of the field trip. The following information

needs to be forwarded to the Assistant Superintendent of Curriculum and Instruction:

 

. Educational Excursion and Bus Authorization Form

. Alabama Course of Study Standards covered by trip

. Itinerary for the entire trip

. Emergency contact numbers (teacher/administrator cell phone numbers)

 

 

Note: Educational trips must require transportation by bus only. The Hickory Public Schools System does not have insurance for vehicles that are not system owned; therefore, the use of private vehicles is PROHIBITED. Activity buses have been purchased by the MCPSS to transport small groups of children to special events and contests. Schools can contact the Office of Transportation

for an activity bus driver. The cost per mile will be determined by the State Department of Education Pupil Transportation Division.

 

II. Important documents that must be completed by the school and parents before students can participate in an overnight excursion:

 

. Permission Slip for Extended/Overnight Excursion

. Emergency and Health Information Form or copy of Student Health Card

 

 

III. Other vital information the school must have on file for overnight excursions:

 

. A copy of the letter or contract from the bus company transporting the students or chaperones to and from the trip destination (letter must include cost of trip and terms of agreement)

 

. A copy of the letter from the organization hosting the event outlining the terms and costs of trip for each student and chaperone

. A copy of the letter from the vendor estimating the cost of meals, if meals are not included in trip package

. Copies of the signed Permission Forms for Extended/Overnight Excursion

. Copies of the completed Emergency and Health Information Forms or copies of Student Health Cards

 

 

Principals’ Responsibilities:

 

The principal is responsible for the approval of field trips, including transportation arrangements and supervisory personnel involved in educational excursions. The principal also is responsible for ensuring to the degree possible the safety and well being of students; therefore, all students are expected to be full participants in all educational excursions. This includes utilizing transportation provided/approved by the school, the supervision by teachers and approved chaperones, and visits to only those places identified on

the permission form. Any deviation from this procedure will require prior notification/approval from the principal.

 

 

 

EMERGENCY AND HEALTH INFORMATION FORM 

 

Student’s Name:                             Telephone #:

Date of Birth:                  Home Address:

Father’s Name:                              Contact Phone #:

Mother’s Name:                              Contact Phone #:

Legal Guardian’s Name:                      Contact Phone #:

Name of contact in case of emergency, if parent cannot be reached:

Emergency Contact Address:

Emergency Contact Phone #:

Family Doctor:

Address:                                    Telephone #:

Health Insurance:                           Company:

Policy # :                                  Telephone #:

Unusual Health Conditions? __YES   __NO   If yes, complete the following:

 

__Diabetes   __Heart        __Convulsive   __Other ____________________________

               Condition      Seizures

 

Allergies   __YES   __NO      If yes, name ___________________________________

Any other health related issues:

If emergency treatment is required and parent cannot be reached, what does the parent want the school to do?    (Please indicate by circling either YES or NO) 

 

1.    Contact closest medical facility?     YES     NO

2.    Contact a physician from local referral agency?     YES    NO

3.    Take child to nearest hospital?     YES    NO

4.    Other Suggestions: 

 

I hereby authorize emergency medical treatment for my child ___________________

                                                             Child’s Name

 

Signature of Parent or Legal Guardian: _______________________________________

 

Date:  ___/___/_____


 

NOTIFICATION OF NON-SCHOOL SPONSORED EXCURSION FORM 

 

 

MEMO TO: Parents and/or Legal Guardian of: ___________________________________

 

FROM: ______________________________

 

RE: Field Trip to: _____________________________________________________

 

DATE: ________/ __________/ __________

 

 

This is to remind you that the field trip to ___________________________________ which is being planned for _______/________/________ is NOT sponsored by the Hickory Public Schools’ Board. This letter is sent to make certain that as parents or guardians of a child who will be participating in the excursion you clearly understand the trip is not in any manner sponsored or endorsed by the Hickory Public Schools System. Neither the School Board nor any of its

employees take responsibility for the trip. Should you have any questions regarding this information, please contact me immediately.

 

 

 

PLEASE COMPLETE AND RETURN THE FORM BELOW

 

 

HOME ACKNOWLEDGEMNT OF NON-SCHOOL SPONSORED EXCURSION

 

This is to verify that I have been advised by ______________________________________ that the trip to __________________________________ which has been planned for

_____/______/_______ is not in any manner sponsored or endorsed by <st1:place w:st="on"><st1:PlaceName w:st="on">Hickory <st1:PlaceType w:st="on">Public Schools, nor any agent, servant, or employee of Hickory Public Schools acting in that capacity. I understand that neither the School Board nor any of its agents, servants, or employees assumes any responsibility for the trip.

 

 

Parent or Legal Guardian Signature:

 

________________________________________________

 

 

Parent or Legal Guardian Name (Please Print):

 

________________________________________

 

Address: ______________________________________________________________________

 

 

 

Participating Student Name (Please Print):

 

___________________________________________

 

 

 


 

EDUCATIONAL EXCURSION VOLUNTEER AUTHORIZATION FORM 

 

This is to verify that I ________________________________ hereby authorize each

                          Principal/School Administrator 

 

of the persons listed below to act on behalf of _________________________School

 

as a volunteer to chaperone students who will be traveling on ___/___/_____ to 

Date  

_______________________________________________________. The purpose of this

                        Destination 

trip is ______________________________________________________________________.

                 

The students will depart at approximately _______ and will return at approximately ____________.

 

The students will be traveling by ________________________________________.

 Mode of Transportation  

 

 

 

List below are the names, addresses, and phone numbers of the adults authorized to act on behalf of the school system in chaperoning students for the above-referenced excursion:

 

NAME

ADDRESS

PHONE #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Done this the _______day of ______________________ 20_____.

 

 

 

____________________________________ ______________________________

Principal Signature                         Date

 

 

___________________________________ ______________________________

Witness Signature                           Date