Author: test

LOOMIS UNION SCHOOL DISTRICT
PARENT PERMISSION FOR SCHOOL RELATED FIELD TRIPS
AND CONSENT TO TREAT
( ) Franklin School ( ) H.C. Powers School ( ) Loomis School
( ) Penryn School ( ) Placer School ( ) Ophir
___________________________________________________________ has the opportunity to take part in school activities away from school. Participation in these events is purely voluntary and requires your written permission. If you approve the following arrangements, please sign at the bottom and return the form to the faculty sponsor or coach.
I understand and acknowledge that Education Code Section 35330 provides that all persons making the field trip or excursion shall be deemed to have waived all claims against the District or the State of California for injury, accident, illness or death occurring during or by reason of the field trip or excursion.
NATURE OF ACTIVITY:
( ) All Athletic Activities during current school year
( X ) Other (indicate activity) 8th grade promotion event
DESTINATION: SunSplash in Roseville
DATE: June 7, 2011 TIME OF DEPARTURE: 9:30 a.m. TIME OF RETURN: 3:00 p.m
MEANS OF TRANSPORTATION: (Sponsor, please check)
A. School bus _____X___ D. Walking __________
B. District owned vehicle _________ E. Bicycle __________
C. Commercial carrier _________
TRIP SUPERVISOR: 8th grade teachers
I further agree in the case of medical emergency, illness, or injury that the supervisor has my express permission to take the above names student to a doctor or medical facility to receive emergency treatment.
_______________________________ __________________________________________________
(Date) (Signature of Parent or Guardian)
IMPORTANT MEDICAL INFORMATION THE SUPERVISOR SHOULD KNOW:
Insurance: ________________________________________ Policy Number: _____________________________
EMERGENCY PHONE NUMBERS: _____________________________________________________________
FOR ATHLETIC EVENTS: THIS FORM MUST BE COMPLETED PRIOR TO THE ISSUANCE OF A CLEARANCE CARD.
FOR OTHER ACTIVITIES: THIS FORM MUST BE COMPLETED FOR EACH ACTIVITY AND SUBMITTED FIVE SCHOOL DAYS BEFORE THE SCHEDULED EVENT.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
PARENTS AND STUDENTS PLEASE NOTE: Permission slip and money must be turned in TOGETHER.
Checks should be payable to your school’s P.T.C., unless you attend Franklin. Franklin checks should be payable to Franklin School. Permission slip and money are due on or before May 26th.
TOTAL COST: $26.00
(Discounted admission $14.50, lunch $6.00, unlimited drinks $2.50, transportation $3.00)