Form61538and6153.1B

(AppendixB) Page1of1

StudentID#

PLEASANTONUNIFIEDSCHOOLDISTRICT

STUDENTFIELDTRIPAUTHORIZATION

Hart Strings 2, 3, Symphonic Band & Wind Ensemble

Thisformmustbeonfileintheattendanceoffice24hourspriortothetrip.Innocasewillthestudentbepermittedonthefieldtripiftheformisnotonfilewiththeparent/guardian(s)signature.

Student'sName: Grade:

Destination andPurpose:San Francisco Symphony Field Trip 1/19/18;

James Logan Band Festival @Logan HS, Union City 3/14/18 (Symphonic & WE only)

DepartureTime:Varies ReturnTime:Varies MethodofTransportation:Bus or parent drivers

StaffSponsor:D. Aquilina NameofMedicalInsuranceCompany:

Group/CoverageNumber:

PeriodofAbsence:Sponsoringstaffmembermustdrawlinesthroughperiodsbelownotincluded.

GradeLevelK-5 / K / 1 / 2 / 3 / 4 / 5
GradeLevel6-12 (Period) A / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8
Teacher'sApproval/Initials

PARENT APPROVAL

YourattentionisdirectedtoEducationCodeSection35330.Thislawstates,inpart,"allpersonsmakingfieldtrips...shallbedeemedtohavewaivedallclaimsagainsttheDistrictortheStateofCaliforniaforinjury,accident,illnessordeathoccurringduringorbyreasonofthefieldtrip".

Further,theparent/guardian(s),byacknowledgingthisfield tripauthorization,fullyunderstandsandrecognizesthatthe student'sparticipationinthisfieldtripisstrictlyvoluntary,notrequired attendance.

FieldTripRegulations:

1.Studentsshallobeyalltransportationruleswhileonthetripincludingreturningtoschoolbythesameformoftransportationasdeparture,unlesspriorwrittenpermissionisgrantedbysiteadministratortoreturnwithparent/guardian)

2.Studentsshallcomplywithallapplicableschoolbus,schoolandfieldtriprulesandshallbesubjecttodisciplineuptoandincludingsuspensionorexpulsionfortheiractionsonafieldtrip.

3.Studentsmaybedeniedfuturefieldtripsandbesenthome,attheparent/guardian(s)expense,iffieldtriprulesarenotobserved.

4.Sponsorsandadultchaperoneswilldiscussfieldtriprulesandsafetywithstudentspriortothefieldtrip.

5.Sponsorswillberesponsibleforobtainingallfieldtripauthorizationforms,aswellastransportingthisinformationonthefieidtrip.

IcertifythatallEmergencyMedicalinformationonfilewiththeDistrictiscurrentasofthedateofthistrip.(Cometotheschoolofficeifthisinformationneedsupdating.)

Parent/Guardian SignatureDate

FieldTripForm61538and6153.1B

Distribution:White:FieldTripTeacher1/27/11

Yellow: SchoolAttendanceOffice

WarehouseForm:#50300