Bonita Elementary School Activity Trip Permission Form

 

  T     To the Parents/Guardians of students in the __________________________________.

                                                                                                                      (Grade/Class)

 

  __    ________________________ is planning an activity trip to _____________________

               (Trip Leader)                                                                                       (location)

                                   

  f       From: _______________________________ to _______________________________.              

                                (date/time of departure)                                  (date/time of return)

 

          Purpose of the activity trip: _________________________________________________

 

    _   _____________________________________________________________________.

 

  T    There will be a cost to the student of $_________, which must be paid by __________

     (Date)

  (I      (If paid by check, it should be made payable to Bonita Activity Fund.)

 

   E   Eating arrangements will be ________________________  at  _________________

                                                                 (money, sack lunch, etc.)                      (location)

 

        The student should bring ___ounces of drinking water in non-breakable containers.

 

 Tr    Transportation will be provided by:___________________________________________.

 

         Special clothing required for this trip will include:_______________________________

 

          _____________________________________________________________.

 

 

 T     The location of the activity requires that each student be able to accomplish the following physical

       

         tasks: ____________________________________________________________________________

 

 T       The location of this activity includes exposure to: (   ) animals, (   ) plants, (   ) water, 

 

(          (      ) stairs or inclined paths, (      ) other_________________________________________.

 

 Th     The schoolís emergency contact for this trip is: _________________________________ who can be

 

r         reached at: ________________________________________________________

 

  O     Other information: _________________________________________________________

 

__     _______________________________________________________________________

Alternative Learning Experience:

 

For those students not participating in the activity trip, an alternative learning

 

experience has been arranged under the direction of ________________________.

 

The student will participate in the following alternative learning experience:

 

______________________________________________________________________

 

______________________________________________________________________

 

 

Fill in the studentís name in one of the choices below.

 

1.    I approve of__________________________________________ participating

                                                     (Studentís Name)

in the activity trip noted above.                                                             

             

OR

 

2.    I do not approve of______________________________________

                                                                      (Studentís Name)

                                  

participating in the activity trip noted above and direct that he/she

 

participate in the alternative learning experience.       

 

I realize that the Districtís liability coverage only applies to injury if negligence is proven against the District and the terms and conditions of the contractual liability coverage provided in favor of the District have been met; in all other circumstances, the studentís health insurance will provide coverage for the studentís injuries.

 

Parent/Legal Guardian: (Please print)

 

Name: ___________________________Telephone No.: ___________________

 

Home Address: ____________________________________________________

 

Signature of Parent/Legal Guardian: ______________________________________