FIELD TRIP INFORMATION / Field Trip Destination: / Address:
Date of Field Trip: / Leaving Time: / Returning Time: / Travelling by: □bus
□walking
Children will participate in activities near water that is 18 inches or more in depth during this trip.
□No □Yes If yes, complete below AND water presence permission section below.
Water activities are NOT planned during this trip.
All children will use a safety harness (safe for persons 20-168 pounds) when riding a school bus.
CHILD & FAMILY INFORMATION / CHILD’S NAME:
Please check the appropriate boxes, sign, and date below:
□ My child does have my permission to go on this field trip.
□ I would also like to go on the field trip. You can count on me to volunteer.
□ My child does not have my permission to go on this field trip and will stay home with me that day.
Parent or Guardian Signature: / Date:
□ No water 18 inches or more in depth present on this field trip. – Do not complete the following section.
WATER PRESENCE PERMISSION SECTIONþChildren will be near water that is 18 inches or more in depth on this field trip.
þYour child WILL NOT be participating in water NOR swimming activities.
þWe will NOT provide more than the required adult: child ratio of 2 adults for every 7 preschoolers.
Due to the presence of water on this trip, ODJFS Child Care Licensing requires that we determine the following even though we will not be swimming nor providing water activities.
Please check the appropriate boxes, add your child’s birth date, sign, and date below:
My child is a:
□swimmer □non swimmer / Child’s date of birth:
I give permission for my child to participate in the above field trip knowing there is a presence of water 18 inches or more in depth.
Parent or Guardian Signature: / Date:
ECDHS104 REV 5/17