6153 – Instruction – Instructional Arrangements – School Sponsored Trips

Policy –
Regulation –
Exhibit – x

Adopted – 3/5/1998
Revised –

___________________________ has my permission to attend (activity/event) which
(Name of Student)

will take place at:__________________________________________________________

Date of event: ___________________________________________________________

Class or group attending: ___________________________________________________

Teacher or leader: _________________________________________________________

Method of transportation: ___________________________________________________

If traveling by automobile, name of driver:___________________________________

1. I understand that all students going on this trip will be responsible in conduct to the bus driver, to teachers or adult sponsors. It is further understood that students will go and return from the event on the transportation provided and that every reasonable caution will be maintained on the trip.

2. I hereby acknowledge that I have been advised that the activities involved in this excursion/field trip or event are are not considered by the district to be of “high risk” to the participants.

Date: __________________________________________________________________

Parent or Guardian Signature: ________________________________________________

WAIVER OF CLAIM (To be Completed for Out-of-State Events Only)

In granting permission to attend, I do hereby waive all claims and hold harmless the individual sponsors, the (School District Name) , and the State of California for any injury, accident, illness, death, or any loss or damage to personal property occurring during or by reason of this excursion/field trip or event.

Date: ___________________________________________________________________

Parent or Guardian Signature:____________________________________________

See Policy #6153
CSBA Date – 3/91

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