FIELD TRIP
PACKET
Fresno Unified School District
Request for Approval of Field Trip Involving Students
Instructions: Submit this form to the principal for all trips outside the Fresno Unified School District boundary.
1. Requests for intra-state travel must be submitted at least two weeks in advance of trip.
2. Requests for out-of-state travel must be submitted at least one month in advance of the trip.
Note:
Information on field trips is contained in policy and procedure 6153.
Sunnyside High School
School
Tasha Hicks / Cesar Zavalza
Teacher
11/25/16
Date(s) Out of District
Football playoff Rooters Bus Sanger High 11/ 25/16
Destination
Composition of the group making the trip (example: 40 biology students, 2 teachers and 4 parents)
100 Sunnyside High School Students & 4 chaperones (Rooters Bus)
Special circumstances relating to this trip:
Rooting for our SHS Wildcat Football team at a game many
students do not have transportation to attend.
Educational purpose:
Funding source:
Student Body - Payments collected from students in advance
Principal’s Signature
Date Request Submitted
(Indicates Approval)
Written parent permission slips must be filed with the principal for all students making the above trip. If the trip
involves Overnight or Out-of-State Travel, the principal should send this form to the Assistant Superintendent,
Secondary Education Office along with a detailed itinerary.
Approved
Denied
Signature of Assistant Superintendent
FRESNO UNIFIED SCHOOL DISTRICT
OFF-CAMPUS RESPONSIBILITY SLIP
Requesting Teacher/Sponsor ___Tasha
Return form to ____Mrs.
1.
2.
3.
Hicks___________ Office Approval _____________________
Hicks / Mr. Zavalza_____
by __Friday,
Nov. 25, 2016___
This form is to originate with requesting teacher or sponsor.
Office approval is to be secured before form is taken to the classroom teacher for signature.
When this form is complete, it is to be returned to the requesting teacher.
TO THE TEACHERS OF ________________________________ Student ID # __________________
With your permission, this student will be excused from class on ______N/A________________
At _____5:00pm__________ to attend ____Football
(Time)
Period
1
2
3
4
HR
5
6
7
8
Rooters Bus
___
(Activity)
Class
Teacher
Approval
Yes
Comment
Teacher
Signature
No
Transportation will be furnished by ______FUSD_____________________________________
CONSENT OF PARENT
I have been advised of the contents of the state of California Education Code Section 35330, which states in
part: “All persons making the study trip or excursion shall be deemed to have waived all claims against the district
of the State of California for injury, accident, illness or death occurring during or by reason of the study trip or
excursion.”
My child is covered by medical insurance: ____________________ Private ________ School
My son or daughter has the following medical problem that should be brought to the attention of the sponsor:
___________________________________________________________________________________
___________________________________________________________________________________
Note: All teachers must approve or the request is denied. Signed: _________________________
(Parent or Guardian)
FIELD/STUDY TRIPS
1. Field/Study trip packets are located in the Main Office mailroom.
2. All trips must be planned well in advance and two (2) weeks notice must be given when teacher
signatures are required. (off campus responsibility slip) Please make sure students understand
that teachers have the right to say NO. It is your responsibility to check all returned offcampus slips and note when a teacher has marked no and enforce it. If this should happen, no
one has the right to overrule the teacher’s decision. “Please note, when the activity is tied to a
class/grade such as Choir, Band, Orchestra, a student will be allowed to attend. Teachers should
still notify Assistant Principal or requesting teacher of any issues/concerns regarding a student
not in good standing, so that steps can be taken to rectify the situation.
3. Complete the field trip packet. Please read attached information regarding transportation
before securing it through Sandy Sarkisian, Financial Technician. All transportation must be
prepaid.
4. Off campus responsibility slips must have the signature of Sheryl Weaver, Assistant Principal,
before distribution. If a C-1 form is necessary for your trip, Cheryl Abrams has the forms and
it must be returned with the following information to Sheryl prior to the trip.
•
•
•
•
•
Completed packet
Student off-campus responsibility slip
Parent consent forms
Final list of all students participating to appropriate University Office
All monies to Sandy Sarkisian, Financial Technician
Policy Concerning Field/Study Trips:
1. All trips must be approved by the Assistant Principal.
2. All trips taken on school time must meet educational objectives.
3. Trips other than classroom related study trips must be taken outside of school time.
4. A certificated adult must supervise all study/field trips.
SUNNYSIDE HIGH SCHOOL
FIELD/STUDY TRIP PLAN SHEET
Tasha Hicks
Student Body
Sponsors Name
Organization/Class
11/25/16
5:00pm
Date of Trip
Time Departure
Depart from
Approximate Time of Return
Sunnyside High
11:30pm
Signature of Department Chairman ________________________________________
Will this involve school time? ____NO_________________________________________
If yes, can your department cover sponsor’s classes? ___________________________
If department cannot cover, how are classes to be supervised? ____________________
Who will cover your classes? List names below:
1. _______________________
2. _______________________
3. _______________________
4. _______________________
5. _______________________
HR
7. _______________________
6. _______________________
_______________________
8. _______________________
If on school time, are you satisfied as to the educational objective? ___________
Assistant Principal _______________________________________________
Transportation tentatively reserved from ____FUSD__________________ Company.
Number of buses __2_____
Approximate total trip cost? ___$______
Have funds been deposited to cover cost? ________
Financial Technician approval _________________________________________
Assistant Principal approval __________________________________________
FRESNO UNIFIED SCHOOL DISTRICT
Parent Consent for Voluntary Field Trip and Emergency Medical
Authorization
To the Principal of
Sunnyside High School
Student’s Name
has my permission to participate in the field trip to
on
_11/25/16_
Student’s #
Rooters Bus FB game Sanger
Departure __5:00pm____ A.M./P.M. Return __11:30pm___
LUNCH
METHOD OF TRANSPORTATION
{
Pupil will be at school during lunch
{
Walking
{
Pupil should bring sack lunch without liquid
{X
School Bus
{
Other ____________________________
{
Private Auto
{
Other _______________________
PARENTS PLEASE NOTE
It is necessary that parents specifically authorize their child to be included in this field trip. While supervision for the
event will be furnished by the school, parents are hereby advised that such supervision by school personnel will occur only
during the time period stated above. Although the school district will take every precaution to assure the welfare and
safety of your child while participating in this activity, it is important you understand that the school district assume no
liability whatsoever in case of injury or accident.
__________________________________________
Approval Signature (Parent/Guardian
__________________________________
Date
(NOTE: TEACHERS DETACH HERE AND TAKE BOTTOM PORTION ON THE FIELD TRIP)
__________________________________________
Student’s Name
Should it be necessary for my child to have emergency Medical
treatment while participating in this trip. I hereby authorize
Fresno Unified School District personnel to use their judgment in
obtaining emergency medical services for my child. I further
authorize any individual selected by Fresno Unified School
District personnel to render such emergency medical treatment
to my child as he/she may deem necessary and appropriate. I
understand that the Fresno Unified School District has no
district insurance which pays the medical or hospital costs that
might be incurred on behalf of my child. Consequently, I
understand that any and all such costs shall be my sole
responsibility. The Fresno Unified School District has previously
made available to me student insurance, which can be obtained at
my own expense.
___________________________________
Student’s ID #
EMERGENCY MEDICAL AUTHORIZATION
(PARENT/GUARDIAN, PLEASE COMPLETE
Parent, Guardian, or Participating Adult
Address
ϕHome telephone Number ϕBusiness Phone
Emergency Telephone Number
PLEASE CHECK HERE IF SPECIAL INSTRUCTIONS REGARDING MEDICAL TREATMENT ARE ON FILE
IN THE SCHOOL.
NOTE: This form must be completed for participation in all field trips conducted by Fresno Unified
School District
within the State of California.