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IJOA-E2 - PARENT/GUARDIAN CONSENT FORM for STUDENT TRAVEL/FIELD TRIP(draft af_6-28-22)

PARENT/GUARDIAN/STUDENT CONSENT

I hereby give my permission for ____________________(student’s name) to participate in the travel/field trip(s) named and described herewith. I acknowledge receipt of the Field Trip Information form for that trip(s). I am comfortable with the arrangements described. I authorize the trip leader(s) to arrange medical treatment in an emergency. I hereby release the trip leader, the field trip(s) chaperones, the school, and the school department (“School”), town of Cape Elizabeth (“Town”), and all of their agents or employees, from any and all claims, liabilities and responsibilities for damages or injuries that my student may experience during this trip, except only any claims for any damages or injuries that may be sustained as a result of any intentionally harmful acts on the part of the trip leader, the chaperone(s), the Town, the School, or their agents or employees. I understand that it is my responsibility to obtain health insurance coverage for medical expenses that may occur.

     
 Parent/Guardian Signature    Student Signature
     
 Date    Date

NAME OF FACULTY/TRIP LEADER (MAKING REQUEST):  

DATE(S) OF PROPOSED TRIP:               # OF SCHOOL DAYS:                             # OF NIGHTS AWAY:

TRIP DESTINATION:

PURPOSE/BENEFIT OF TRIP:

TRANSPORTATION ARRANGEMENTS:

# STUDENTS:                     

#CHAPERONES:                            # SCHOOL STAFF:                      #PARENTS/OTHER:

ARRANGEMENT FOR MIXED GENDER SUPERVISION:

COST PER STUDENT:

DESCRIPTION OF ANY FUNDRAISING:

DO ALL MEMBERS OF THE GROUP/TEAM HAVE AN OPPORTUNITY TO PARTICIPATE?    YES       NO

IF NOT, DESCRIBE CIRCUMSTANCES:

FOR OVERNIGHT TRIPS:

ALL PARENT/OTHER CHAPERONES HAVE ATTENDED VOLUNTEER TRAINING

DATE/TIME OF PRE-TRIP CHAPERONE MEETING:

FOR OUT OF COUNTRY TRIPS:  TRAVEL AND CANCELLATION INSURANCE ARRANGEMENTS (ATTACH COPY OF CONTRACT WITH INSURANCE AND CANCELLATION PROVISIONS HIGHLIGHTED).

APPROVAL OF TRAVEL:

Principal or AD: _______________________________________DATE: ______________

Superintendent: _______________________________________DATE: ______________

School Board: _______________________________________DATE: ______________

 

   All travel must first be approved and recommended by the principal or, in the case of athletic trips, the athletic administrator. The principal and athletic administrator are permitted to approve in-state day trips (no overnight stays) without the endorsement of the Superintendent or School Board.
   Out-of-state trips within New England and in-state requiring no more than one night's stay must be approved by the Superintendent.
   Board approval is required for Trips outside of New England; for all trips requiring two or more overnight stays; and for all trips requiring a per-student cost or fund-raising of $500 or more.
   Travel requests needing approval from the Superintendent of Board should be submitted at least two months of the trip.

Cross Reference: 

Form Revised: 

  • January 11, 2022
  • March 10, 2015
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