Darnell-Cookman SoMA
Field Trip Checklist
Coordinator___________________________
Location(s)____________________________
Date_______________________________
Field trip request form filled out
At least 6 weeks before the trip (Activities Director’s Initials)
Financial plan developed, receipt book checked out
At least 6 weeks before the trip (Bookkeeper’s Initials)
Criteria for student attendance discussed with your administrator
At least 6 weeks before the trip (Administrator’s initials)
Field trip forms distributed, along with criteria for attendance
At least 6 weeks before your trip (Your initials)
Buses reserved (charter or school)
At least 5 weeks before the trip (Your initials)
For out of county trips, administrative attendee recruited
At least 5 weeks before the trip (Administrator’s initials)
Detailed trip itinerary submitted, including times and locations
At least 4 weeks before the trip (Activities Director’s Initials)
Parent Chaperone forms submitted, background screening verified
At least 2 weeks before the trip (Activities Director’s Initials)
TDE forms filled out for ALL faculty/staff serving as chaperones with Field Trip
request form attached for documentation
At least 2 weeks before the trip (Principal’s Secretary’s Initials)
Final list of attending students submitted
At least 2 weeks before the trip (Activities Director’s initials)
Plan submitted for holding students who stay at school
At least 1 week before the trip (Activities Director’s initials)
Permission slips submitted and copied to bring along on the trip
At least 1 week before the trip (Activities Director’s initials)
School Name:
DARNELL-COOKMAN SOMA
C
FIELD TRIP REQUEST FORM
Classes/Grade Level(s) Going:
Today's Date:
Name of Person Submitting Request:
Location of Field Trip:
Number of Students:
Cost Per Student:
Purpose of Trip and how it relates to the curriculum:
Departure:
Date:
Time:
Return:
Date:
Time:
ALL CHAPERONES MUST BE CLEARED/PRE-SCREENED 5 DAYS BEFORE TRIP!!!
Chaperones:
1
5
2
6
3
7
4
8
This Field Trip Request is approved with the understanding that proper safe precautions will be
observed and that all School Board Regulations (EEAG, EEAFA, and IJOA) will be followed.
When all signatures have been obtained, this form becomes the sponsor authorization to conduct
the described field trip.
** Submit three weeks prior to trip**
Faculty Member / Date
Principal / Date
Cafeteria Manager / Date
(Must have 3 weeks notice)
Bookkeeper / Date
Duval County Public Schools
DARNELL-COOKMAN SCHOOL OF THE MEDICAL ARTS
Parent Release Form - Field Trip
I / We consent to
going to
Student's Name
for supervised
on
Field Trip Destination
Date
activities, and agree to release and discharge the Duval County School
Board, its officers, agents and employees, exercising reasonable care
within their scope of employment, from liability growing out of personal
injuries and property damage resulting or occuring during the afore
mentioned activities, or in transit to and from said activity.
***REFUNDS CANNOT BE ISSUED FOR ANY REASON.***
Departure Time:
AM
PM
Return Time:
AM
PM
Cost/fee:
CONTACT INFORMATION:
(In case of an emergency)
Home Phone Number:
Work Phone Number:
Cell Phone Number:
SPECIAL INSTRUCTIONS/CRITERIA FOR STUDENT ATTENDANCE
Parent/Guardian Legal Signature
Date
Duval County Public Schools Medical Release Form
(For Out of County Trips)
School Name/#:
Student's Name (Please Print)
In the event of a medical emergency, I give permission to School Board Personnel to authorize
whatever treatment is necessary and I will accept liability for payment of any bills related to the
treatment.
Effective Date(s):
Signature of Parent:
Date:
Insurance Company:
Policy #:
Please list any medical conditions/problems or special needs (include medications) in the box
below. Medications will only be administered by either School Board Personnel or appropriate
Medical Personnel in the case of an emergency. (Complete a Parent Permission Form for
Medication Administration).
Parent's Signature
IN CASE OF EMERGENCY:
Contact Person (Please Print)
Phone Numbers:
Home:
Work:
Cell:
Other Emergency #s
Name:
Phone:
Name:
Phone:
H
DUVAL COUNTY PUBLIC SCHOOLS
CHAPERONE RESPONSIBILITIES ON FIELD TRIPS
I
School Name:
The following list identifies your responsibilities as a chaperone when accompanying
students on Duval County Public School field trips.
Please review the list, sign and return to your child's teacher by
if you are interested in being a chaperone.
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Must be 21 years old or a parent of a student going on this field trip.
Must be cleared through the volunteer screening process.
No children except for those in the participating class or group may attend this field trip.
Accompany students on the bus and assist as needed.
Provide close supervision of small groups (no more than 10 students)
A list of names in your group will be provided to you.
Medications will only be administered to students by school personnel.
Follow assigned agenda of activities.
No tobacco or alcholic beverages are permitted on field trips.
NO SWIMMING IS ALLOWED on any field trip.
IMMEDIATELY report ANY PROBLEMS directly to the teacher.
Arrive promptly for departure of trip.
Will attend orientation for out of county trips.
Parent Signature
Date
Student's Name (Please Print)
DUVAL COUNTY PUBLIC SCHOOLS
STUDENT RELEASE FORM
I,
J
, will take full responsibility
Parent's Name
for my child,
, at the end of the
Child's Name
. I will be responsible for the
on
Field Trip Destination
Date of field trip
supervision and transportation of my child. I release the Duval County School
Board, ALL of its employees, and the bus contractor from any liability for my child.
Parent's signature
Date
Teacher's Signature
Date
Principal's Signature or Witness Signature if Principal is unavailable
Date