Parent/Guardianconsentformand Indemnityagreement(Step4)

revised10/30/2012

Parent/GuardianConsentFormand IndemnityAgreement(Step4)

In or a Surrounding County FieldTrip

(Duval,Baker,Bradford,Clay,Nassau,St.JohnsorUnion)

Teacher/Class/Group: Senior Class of 2015

willbeattendingafieldtripto Times Union Center for Performing Arts – Graduation Practice

Departing on6.2.15at8:00am /pmReturningon6.2.15at 12:00am /pm

(date)(timeleavingschool)(date)(estimatedtimebackatschool)

LunchInfo/Instructions:

Mode ofTransportation:School Bus TotalCostperStudent:$ 0

TotalVolunteerChaperonesneededforfieldtrip:(=Male +Female) CostperChaperone:$

(Notalltripsrequiremultiple‐genderchaperones.“n/a”inparentheses()aboveindicatesmultiple‐gendersarenotrequiredornumbersindicateamountsneeded.)

PaymentInstructions: OtherInformationand/orInstructions:

Return with payment no laterthan*

*Refundsmaynotbeissuedafterthisdate.

PleasePrint:

(Parent/Guardian),grantpermissionfor(Student) to participate in the field trip as stated above for supervised activities, and agree to release and discharge the School Board ofDuvalCounty, Florida, its officers, agents and employees, exercising reasonable care within their scope of employment, fromliabilitygrowingoutofpersonalinjuriesandpropertydamageresultingoroccurringduringtheaforementionedactivities,orintransittoand from said activity. EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I give permission for my child toreceive medical treatment. In case of an emergency, pleasecontact:

1stEmergencyContact:

(printname)

Relationship:

Cell#:Work#:Home#:

2ndEmergencyContact:Relationship:

(printname)

Cell#:Work#:Home#:

Ifthestudentneedsmedicationduringthefieldtrip,aPermissionforAdministrationofMedicationformmustbecompletedandbrought to the school with the medication by the parent/guardian a minimum of two school days prior to the field trip date. Ablankformmaybeobtainedfromthestudent’steacherortheschool’sfrontoffice.

AsParentorGuardian,Iagreetoalloftheabovestatedconsiderationsandconditions:

Parent/Guardian:

(Signaturerequired)

Date:

PersoninterestedinservingasVolunteerChaperoneduringthistrip:**

(printname)

Relationship tostudent:Contact Phone#:

**PersoninterestedinparticipatingasaVolunteerChaperonemustbean“approved”volunteerwiththeDistrictpriortothefieldtripdate.

Ifhe/shehasnotappliedtobeavolunteerwithinthelasttwoyears,he/shemaydosoviatheinternetat

Parental/Guardian ConsentForm andIndemnityAgreement(Step4A)

Out-of-County FieldTrip

Teacher/Class/Group:

willbeattendingafieldtripto

Departing onat:am /pmReturning onat:am /pm

(date)(timeleavingschool)(date)(timebackatschool)

Lunch: (drop down menu)Other:

Mode ofTransportation:Cost per Student:$*Refundsmaynotbeissuedafterthedatebelow.

PaymentInstructions:Return form with payment no laterthan*

*Paymentsreceivedafterthisdatemaynotguaranteeyourchild’sparticipationinthefieldtrip.

(Parent/GuardianName),grantpermissionfor(StudentName) to participate in the field trip as stated above for supervised activities, and agree to release and discharge the School Board ofDuvalCounty, Florida, its officers, agents and employees, exercising reasonable care within their scope of employment, fromliabilitygrowingoutofpersonalinjuriesandpropertydamageresultingoroccurringduringtheaforementionedactivities,orintransittoandfromsaidactivity.Intheeventofanemergency,Igivepermissionformychildtoreceivemedicaltreatment.

A “Medical Release Form” must be completed, signed, and taken on the field trip for each student during an out‐of‐county fieldtrip.Students who do not have a completed and signed Medical Release Form on the day of the field trip will not be able to attendthefieldtripandarefundmaynotbeprovided.

Ifthestudentneedsmedicationduringthefieldtrip,aPermissionforAdministrationofMedicationformmustbecompletedandbroughtinbytheparent/guardian(withthemedication)aminimumoftwoschooldayspriortothefieldtripdate.AblankformmaybeobtainedfromtheTeacherorfrontoffice.

AsParentorGuardian,Iagreetoalloftheabovestatedconsiderationsandconditions:

Parent/Guardian:

(Signature)

Date:

Cuthereandkeepbottom“FieldTripReminder”portion.

‐‐‐‐‐‐‐ ‐‐‐‐‐‐‐ ‐‐ ‐‐‐‐‐ ‐‐ ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ ‐‐‐ ‐‐‐‐‐‐‐‐ ‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐‐ ‐‐‐‐ ‐‐‐‐ ‐‐ ‐‐‐ ‐‐‐‐‐‐‐‐‐‐ ‐‐‐‐‐‐‐‐ ‐

FieldTripReminder

Student:Approx.ChaperoneVolunteer(s)willbeneeded.Teacher/Class/Group: willbeattendingafieldtripto Departing on at : am /pm Returning on at : am / pmLunch: (drop down menu)Other: Mode ofTransportation: Cost per Student:$ *Refundsmaynotbeissuedafterthedatebelow. PaymentInstructions: Returnformwithpaymentnolaterthan *

*Paymentsreceivedafterthisdatemaynotguaranteeyourchild’sparticipationinthefieldtrip.

Important: A Medical Release Form is required for each student on out‐of‐county field trips. Also, if the student needsmedicationduring the field trip, a Permission for Administration of Medication form must be completed and brought in by theparent/guardian(withthemedication)aminimumoftwoschooldayspriortothefieldtripdate.Thisblankformmaybeobtainedfromtheschool.

Page 1 of2

Medical Release Form (Step5A)

Out-of-County FieldTrip

Pleaseclearlyprintinformation,signbelow,andreturnwithParent/GuardianConsentform.

Student:DOB:

School:FieldTrip:

Field Trip DepartureDate:Field Trip ReturnDate:

Intheeventofamedicalemergency,IgivepermissiontoSchoolBoardPersonneltoauthorizewhatevertreatmentisnecessaryandIwillacceptliabilityforpaymentofanybillsrelatedtothetreatment.

InsuranceCompany:

PolicyNumber:EffectiveDates:

Policy HolderName:

List any medical issues or special needs below, in addition, please note that a PermissionforAdministration of Medication form must be completed in order for any DCPS personnel to be authorizedtoadministeranymedicationtoastudent.

In case ofemergency:

1stEmergency Contact (pleaseprint):

Cell:_()Home:_()Work:_()

2ndEmergencyContact(pleaseprint):

Cell:_()Home:_()Work:_()

3rdEmergencyContact(pleaseprint):

Cell:_()Home:_()Work:_()

AsParentorGuardian,Iagreetoalloftheabovestatedconsiderationsandconditions.

Parent/GuardianSignature:Date:

Page 2 of2

revised10/30/2012

PermissionforAdministrationofMedication(Step5)

IMPORTANTREQUIREMENT:

AllmedicationsmustbephysicallybroughttotheschoolofficebytheParent/Legal Guardian. (No medication may be handed to school personnel by a minorchild.)

PrescribedMedication

Student:DOB:_School:_

Name ofMedication:Doctor:_

PrescriptionNumber:Date ofPrescription:

I,,grantpermissionfortheprincipalortheprincipal’sdesignee

(Parent/LegalGuardian)

toassistintheadministrationofprescribedmedicationformychild/legalward,

(Student)

I certify that the prescribed medication is in its original container and that it is necessary, according tomydoctor’s instructions, for this medication to be provided during the school day, including when my childisaway from school property on official school business. I understand that this medication will be givenonlyaccording to the directions on the label as prescribed by the doctor. I further understand that it will bemyresponsibilitytopickupanyunusedmedication,within30daysattheendoftheschoolyear.

Parent/Guardian:Date:_

(Signature)

Non-Prescription (Over-the-Counter)Medication

Student:DOB:_Weight:

School:

I request that my child/legalward,, begivenexternaland/orinternalmedicationidentifiedbelowduringtheschoolday,includingwhenmychildisaway from school property on official school business. I will provide the medication in its originalcontainer.Iunderstandthatsuchmedicationwillbegivenonlyaccordingtothefollowingdirections:

Medication:Amount:When: (Directionsfromtheparent/guardianmaynotexceedthemedicationinstructionsonthelabel.)

DateMedicationtobeDiscontinued:

Further,Iagreetowaiveanyclaimsofliabilitythatmayariseagainstanyschoolpersonnelrelativetotheadministrationofmedicationtomychildaccordingtothesedirections.

Parent/Guardian:Date:_

(Signature)

REPORT OF MONIESCOLLECTED(StepS)

DATE:

ACCT NAME andNo:

MONIESOBTAINEDFROMSOURCEINDICATEDBELOWARETRANSMITTEDHEREWITH FORDEPOSIT

Student ActivityReceipts/CommunityEducation ReceiptsAttached:

Beginning No.------

EndingNo._

Voided SARJCER Nos. (List all)

Source: / $
$

/S/-----:-::-----=---:--:------

sponsor orTeacher)

IHEREBY CERTIFYTHEABOVEFUNDSAREALLRECEIVEDBYMEFORDEPOSIT.

/5/-:------

(FimneialA:.lorPrincipal)

Iffundswereheldorshonageexists.principal'ssignatureisrequired.

lSI

(Principal)

Pageof

BagLunchRequestForm(Step7)

revised10/30/2012

InoraSurroundingCounty(Duval,Baker,Bradford,Clay,Nassau,St.JohnsorUnion)

Submit, even if NO bag lunches are needed, to Cafeteria Mgrtwo weeks prior to field trip date.AllStudents(PAID,REDUCED,andFREE)canorderabaglunchforafieldtrip.AlllunchesmustbepaidforandaccountedforwhentheyarepickedupbythestudentANDtheteacher.

FIELD TRIPDate:Date ofRequest:

Teacher:

•Check this box if NO bag lunches are needed:□

Room#:

•Total number baglunches:(liststudentsbelowanduseanotherformifneeded)

Student IDNumber / Student LASTName / Student FIRSTName / StudentPick-upLunch
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Teacher: Provideacoolerforlunchestobeplacedin.ReturnAccountabilityRosterafterthefieldtrip.

CafeteriaManager:ThisformandtheAccountabilityRoster,checked-offonthefieldtrip,mustbemaintainedwithyourdailyreports.

Bag Lunch Request Form ~ OUT-of-County Field Trip (Step7A)

Submit,evenifNObaglunchesareneeded,toCafeteriaMgrthreeweekspriortofieldtripdate.AllStudents(PAID,REDUCED,andFREE)canorderabaglunchforafieldtrip.AlllunchesmustbepaidforandaccountedforwhentheyarepickedupbythestudentANDtheteacher.

FIELD TRIPDate:Date ofRequest:

Teacher: Check the box if NO bag lunches are needed:□

Room#:

Total number baglunches:(list studentsbelow)

Student IDNumber / Student LASTName / Student FIRSTName / StudentPick-upLunch
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.

Teacher: Provideacoolerforlunchestobeplacedin.ReturnAccountabilityRosterafterthefieldtrip.

CafeteriaManager:ThisformandtheAccountabilityRoster,checked-offonthefieldtrip,mustbemaintainedwithyourdailyreports.

INTERNALACCOUNTS(Step8)

REQUEST FOR PURCHASE APPROVAL ANDCHECK REQUISITION

------SCHOOLNO.__

ITISREQUESTEDTHAT

(ACCOUNT NAME ANDNUMBER)

--

BEENCUMBEREDFOR

(PURPOSEFORPURCHASEOFMERCHANDISE/SERVICEUSTEDBELOW)

PRICEISNOTTOEXCEEDSTOBEPURCHASEDFROM------

REQUESTINGAUTHORlZATION

(FACULTY/STAFF MEMBER'SSIGNATURE)

FUNDSAVAILABLE

(SCHOOL FINANCIAL AGENT'S SIGNATURE)

APPROVEDFORPURCHASE------

(PRINCIPAL'SSIGNATURE)

*********************************************

DATE------

DATE_

CHECKISTOBEMADEPAYABLETO_

ACCOUNTTOBEPAIDFROM------

FORTHEAMOUNTOF$

REQUESTINGPAYMENT

TRANSACTIONCODE

DATE------

(FACULTY/STAFFMEMBER'SSIGNATURE)

APPROVEDFORPAYMENTDATE

(PRINCIPAL'SSIGNATURE)

CHECKNUMBER

ATTACHADDITIONALPAGESIFNEEDEDPAGEOF

revised10/30/2012

VolunteerChaperoneResponsibilityForm (Step9)

FieldTrip:on(date)

Thefollowingidentifiesrequirements,responsibilities,andexpectationsforaVolunteerChaperonetoaccompanystudentsonDuvalCountyPublicSchoolsfieldtrips.Pleasereview,sign,andreturntotheteacherassoonaspossible.

1.Volunteer Chaperones for field trips are to be in accordance with the School Board policy 9.63 “SchoolVolunteers/ScreeningProcess”and4.45“ChaperonesforSchoolFunctions.”

2.VolunteerChaperonesmustbe21yearsofageoraparent/guardianofastudentparticipatinginthefieldtripandarerequiredtocompleteavolunteerapplicationandbeapprovedbytheDistrictpriortothefieldtrip.Theapplicationmaybefoundat

3.VolunteerChaperonesmaynotbringayoungerchild(e.g.student’ssibling)onthefieldtrip.AbsolutelynootherchildrenexceptfortheDCPSstudentsinaparticipatingclassorgroupmayattendthefieldtrip.

4.Volunteer Chaperones are asked to provide close supervision of small groups of no more than 10 students andshouldcoordinatewiththeteacherforalistoftheir10studentnames.

5.VolunteerChaperonesandtheteacher/sponsorareaskedtoexchangecontactphonenumbers,e.g.Chaperone’scell,Sponsor’scell,schoolnumber,etc.incaseofemergenciesduringthefieldtrip(allnumbersaretobekeptconfidential).

6.Volunteer Chaperones are to arrive at the school prior to the departure time of the field trip for final instructions and aretofollowassignedagendaofactivities.

7.Volunteer Chaperones may be requested to accompany students on the approved mode of transportation or providetheirown transportation then gather at the destination (based on available seating and number of volunteerchaperonesparticipating).

9.Volunteer Chaperones are to IMMEDIATELY report ANY PROBLEMS directly to the teacher/school employee presentduringthe fieldtrip.

10.VolunteerChaperonesarenotallowedtoprovideoradministeranymedications(over‐the‐counterorprescription)tostudents. Medications will only be administered to students by school employees in accordance with the SchoolBoardPolicy5.62“AdministrationofMedication.”

11.Notobaccooralcoholicbeveragesarepermittedduringthefieldtrip.

12.Itisstrictlyprohibitedforstudentstoparticipateinanywater‐relatedactivitiessuchasswimming,boating,waterskiing,etc. on any fieldtrip.

Iagreetoadheretotheaboverequirements,responsibilities,andexpectationsandIhavecompletedtheDuvalCountyPublicSchoolsVolunteerApplicationwithinthelasttwoyearsfromthedatebelow.

SignatureofVolunteerChaperoneDate

CostperChaperone$

Returnthisformwithpaymentnolaterthan

PrintName(aslistedonDCPSVolunteerApplication)

Tobecompletedbyschool’sVolunteerLiaison;signanddatewhereapplicable:

Approved: NotApproved:

NeedApplication:

Date:Date:Date:

revised10/30/2012

VolunteerAttendanceonFieldTripForm

(Not a Chaperone) (Step10)

FieldTrip:on(date)

The following identifies requirements, responsibilities, and expectations for a Volunteer to accompany students on DuvalCountyPublicSchoolsfieldtrips.Pleasereview,sign,andreturntotheteacherassoonaspossible.

1.Volunteer attendance on field trips is to be in accordance with the School Board policy 9.63 “SchoolVolunteers/ScreeningProcess.”

2.Volunteersmustbe21yearsofageandarerequiredtocompleteavolunteerapplicationandbeapprovedbytheDistrict

priortothefieldtrip.Theapplicationmaybefoundat

3.VolunteersarenottosupervisestudentsunlesstheyhavesignedtheVolunteerChaperoneResponsibilityForm.

4.AbsolutelynootherchildrenexceptfortheDCPSstudentsinaparticipatingclassorgroupmayattendthefieldtrip.Volunteersmaynotbringanotherchildonthefieldtripthatdoesnotcomplywiththisguideline.

5.Volunteersaretoprovidetheirowntransportationthengatheratthefieldtripdestination.

6.Volunteers are to IMMEDIATELY report ANY PROBLEMS directly to the teacher/school employee present during thefieldtrip.

7.Volunteers are not allowed to provide or administer any medications (over‐the‐counter or prescription) tostudents.MedicationswillonlybeadministeredtostudentsbyschoolemployeesinaccordancewiththeSchoolBoardPolicy5.62“Administration ofMedication.”

8.Notobaccooralcoholicbeveragesarepermittedduringthefieldtrip.

Iagreetoadheretotheaboverequirements,responsibilities,andexpectationsandIhavecompletedtheDuvalCountyPublicSchoolsVolunteerApplicationwithinthelasttwoyearsfromthedatebelow.

Signature ofVolunteerDate

Cost per Volunteer$

Returnthisformwithpaymentnolaterthan

PrintName(aslistedonDCPSVolunteerApplication)

Tobecompletedbyschool’sVolunteerLiaison;signanddatewhereapplicable:

Approved: / Date:
NotApproved: / Date:
NeedApplication: / Date:

revised02/26/2014

StudentReturn-TransportReleaseForm (Step11)

I,,willtakefullresponsibilityformychild,

(Parent/GuardianName)

, at the end ofthe

(ChildName)(Fieldtrip/Eventdestinationordescription)

field trip/ eventon.Iwillberesponsibleforthesupervisionandtransportationofmy

(Date of fieldtrip)

Childattheconclusionofthefieldtrip/event.IreleasetheDuvalCountySchoolBoard,ALLofitsemployees,andthebuscontactorfromanyliabilityformychild.

Date_ Parent/Guardian Signature

Date_ TeacherSignature

Date_ PrincipalSignature

orPrincipal’sDesignee(ifPrincipalisunavailable)

THEDUVALCOUNTYSCHOOLBOARD

APPLICATIONFORABSENCEOFALLPERSONNELFROMREGULARWORKLOCATIONS(Step12)

NAMER/C#DATE

(PleasePrint)

PIN:POSITION

LEAVE USED: Check appropriateitem

SICKANNUALPERSONALTDELEAVEW/OPAYPROFESSIONALILLNESS/INJURY ORIGINALDATEOFINJURY COURT/JURY MILITARY

SICK LEAVEPOOLOTHER

DATESLEAVE

USED

/ #HRSFROMTO

DATESLEAVE

USED

/ #HRSFROMTO

DATESLEAVE

USED

/ #HRSFROMTO

DATESLEAVE

USED

/ #HRSFROMTO

Reason orexplanation:

IfrequestedSickLeaveisnotforemployee,completethissection:

IllnessOrDeathof relative/member ofhouseholdRelationshiptoEmployeeName ofrelative Address ofrelative

EMPLOYEESIGNATUREAUTHORIZEDSUPERVISOR

Approveonlytheavailablebalanceofrequestedtype leave. Otherwise chargeas:

AuthorizedLeaveWithoutPayUnauthorizedLeaveWithoutPay

Directionsforfilingleaverequests:

1.Thisformisdesignedfor“shortterm”absencesandmustbefiledwhenanemployeeisabsentfromhis/herregularduties.Allrequestsshouldberoutedthroughtheappropriatesupervisorand“original”(whitecopy)senttothePayrollOffice.

2.EmployeesarerequiredtofurnishsuchinformationandadditionaldocumentationasmaybeneededbaseduponcurrentSchoolBoardpoliciesandbargainingagreements.(e.g.doctor’sstatements,subpoenas,deathnotices,militaryorders,etc.)

3.ConsecutivenumberofSickLeavedaysusedrequiringadoctor’sstatementisdependentuponcurrentSchoolBoardpolicyandbargainingagreements.Thedoctor’sstatementshouldstatethelengthoftime.

SpecialNotes

1.Sick–Forillnessofemployeesorothers(baseduponSchoolBoardpolicyandbargainingagreements).

2.Annual–Allowednumber of days usedperyearbaseduponSchoolBoardpolicyandbargainingunits.

3.Personal–Limitssetbypolicyandbargainingagreements.LeaveusedreducestheavailableSickLeavebalance.

4.TDE–RequiredapprovalbaseduponSchoolBoardpolicy.

5.LWOP–AllowednumberofdaysusedperyearbaseduponSchoolBoardpolicyandbargainingagreements.

6.Professional–AllowednumberofdaysusedbaseduponSchoolBoardpolicyandbargainingagreements.

7.Illness/Injury(LineofDuty) andcorrespondingdate;Doctor’sStatementrequired.

8.Court/Jury–Proofofattendancerequired.

9.Military–Copyofordersrequired(mustbesentthroughPersonnelDivisionforapproval).

10.SickLeavePool–EligibilitybaseduponSchoolBoardpolicyandbargainingagreements.

PSR-4026

FOR OFFICE USEONLY

DUVAL COUNTY PUBLICSCHOOLSUNIVERSAL FIELD TRIP EXPENSE VOUCHER (Step 13)

UV0000000

Section I -- GeneralInformation

School: / School#: / Date ofTrip:
Class orGroup: / # ofStudents:
Bus#:Bus Driver'sName: / Attendant'sName:
R/C#:Fund#: / Function#: / 7800 / Object:310

Purpose:Bookkeeper's PhoneNumber:

Section II -- Trip Mileage/Time Begins and Ends at the Place ofPickup/Return

Trip DepartureDate:

Trip BeginningOdometer: Site ArrivalOdometer:

Last Site DepartureOdometer: Trip EndingOdometer:

Trip ReturnDate:Trip BeginningTime:Site ArrivalTime:

Last Site DepartedTime:Return ArrivalTime:

Total TripMiles:Total TripTime:

FIELD TRIP SITE ITINERARY (MUST BE COMPLETED)

Site#1:Site#3:

Site#2:Site#4:

(Movement between sites 1-4 is considered single sites for item A and B in SectionIII)

Comments:

Breakfast

LunchDinner

X=$

($30.00/day maximum per driver/attendant) (ReceiptsRequired)

E. OtherExpenses:=$

OPTIONII

Total Field TripCosts:$ Contracted Provider (CommonCarriers)

Amount agreed for service: $

I will provide services for the amountagreed.I hereby certify that I accept the quoted price and conditions for thistrip.

Contracted Provider'sSignatureDatePrincipal's SignatureDate

Section IV --CertificationContractorName:

ContractorAddress:

ContractorFIN:Vendor#:

Verifiedby

Bookkeeper'sSignatureDate

Approvedby:

Principal'sSignatureDate

REVISEDJULY2007

Section I -- GeneralInformation

School - Name and school number.

Date of Trip - Month, day and year of trip.

UNIVERSAL FIELD TRIP EXPENSE VOUCHER INSTRUCTIONS

Class/Group - Grade level, section or type group, (i.e. 5th grade, football team, work program,etc.).Number of Students - Total number of students on this bus.

Bus # - Number of thebus.

BusDriverandAttendant-Nameofthebusdriverandattendant(ifapplicable).NOTE:Attendantsemployedbythebuscontractorarerequiredifaspecial needs ESE student is transported on an ESE bus.

Fund Center - The school's responsibility center number.

Fund-Thefundnumberwillbe10000unlessthetripisfundedfromFederalFunds.FederalFundsareaDistrictexpenseNEVERInternalAccounts.Function-Thefunctionwillbe7800. (NOTE:Forspecialprojects,contactprojectmanagerforfunctioncodesotherthan7800)

Transaction Code/Commitment Item - The object will be310.Purpose - Reason fortrip.

Destination Sites - Brief itinerary of where group is going.

SectionII--TripMileage,BeginandEndTimes,andItinerary.(THISSECTIONMUSTBECOMPLETEDBYTHETRIPSPONSORFORTHEFIELDTRIPAUDIT.)Mileage-TripDepartureDateisthedatethetripbeginsandtheTripReturnDateisthedatethetripends.

Trip Beginning Odometer is the odometer reading at the school center.

Site Arrival Odometer is the odometer reading at site (1st site in multi-site field trip).

Last Site Departure Odometer is the odometer reading at site, prior to return to school center.

TripEndingOdometeristheodometerreadingwhenbusreturnstoschoolcenter.(NOTE:Ifthebusleavesfieldtripsite,only theodometerreadingtositeandreturnfromsitecanbeclaimed. Thisactionmustberecordedinthe"Comments"sectionofthevoucherby theTripSponsor.)

Enter the Total Tripmiles.

Time-BeginningTimeisthetimerequestedforthebustoarriveattheschoolcenter,usuallyten(10)minutespriortoloading.Ifthebusarriveslateto the pickup point, compensation begins at the time the bus arrived.

Site Arrival is the time arrived at thesite.

Last Site Departed Time is the time leaving the site directly for the school (last site in multi-site fieldtrip).Return Arrival Time is the time arrived at the school center.

TotalTripTime-Totaltimethedriverisemployedfortrip. (NOTE:Ifdriverdropsoffthegroupandleavesthesite,thenreturnsatpickuptime,onlythe

timeonsitemay beclaimedby thedriverforpaymentpurposes.)Thesponsormustmakearecordofthedriver'stimeon-siteinthe"Comments"section of the voucher in order to validate the drivers on-site hours.

Field Trip Site Itinerary - List site locations in these slots for multi-site trip. (MUST BE COMPLETED.)

CommentsandSponsor'sVerificationSignature-SponsorverifiestheaccuracyofinformationlistedinSectionII.(Pleaseaddcommentsinthissectionor use an attachment ifnecessary.)

SectionIII--FundingFieldtripsmaybepaidviaaPurchaseOrderusingDistrictfundsfromtheschool'sbudget,orviaaPurchaseApproval/CheckRequisitionFormusingtheschool'sInternalAccounts.CommonCarriersmayONLYbeusedwhenallDuvalCountyContractors decline to provideservice.

SourceofFunds-Placeacheckmarkintheappropriatebox. IfthetripispaidfromInternalAccountfunds,inserttheCheckNumberand

thePurchaseRequisitionNumber.KeepvoucherwithyourRequestforPurchaseApprovalandCheckRequisitionForm.Ifthetripistobepaidforby"OtherDepartment,"forexample: Community Education,TitleI,Magnet,etc.,placeacheckmarkintheappropriateboxandwritetheprogramname.

Option I Line A - Insert the Total Trip Time (NOTE: One (1) hour minimum). The compensation is paid in 15-minute increments after the first hour. Multiplythatnumberbytheperhourrateforthedriverand/orattendanttogetthedollaramountfortotaltime.(Sixteenhoursperdaymaximum.)

LineB-InserttheTotalTripMiles.Multiplythatnumberbythepermileratetogetthedollaramountforthetotalmiles.Totalmilesarepaidinmileage tenth increments (.1, .2, .3, etc.) for any distance less than one mile.

LineC-AContractor'sbusattendantisrequiredwhenastudentisinawheelchairorneedsspecialassistance. Thecompensationispaid

in15-minuteincrementsafterthefirsthour. (Attendantcompensationtimestartsandstopsattheschoolcenter,basedontheagreedtime.

LineD-GeneralRuleforOvernightTravelOnly:TheContractorshallbecompensatedfortheactualcostofmealsupto$30aday,documentedby original receipts, provided to the trip sponsor before the end of the trip.

(1)Breakfast: When travel begins before 6:00 a.m. and extends beyond 8:00a.m.

(2)Lunch:Whentravelbeginsbefore12:00noonandextendsbeyond2:00p.m.

(3)Dinner: When travel begins before 6:00 p.m. and extends beyond 8:00 p.m., or when travel occursduringnighttime hours due to specialassignments.

(4)Theindividualmealallowancemaynotbeclaimedforadayoftravelifsubsection(a)appliesforthatday.

(a)Restriction:Noreimbursementisauthorizedforanymealwhichismadeavailablewithoutspecificcharge. Hourofdepartureandhourof return must be shown for alltravel.

OptionII SourceofFunds–Placeacheckmarkontheappropriateline. IfthetripispaidfromInternalAccountfunds,insertthechecknumber

andkeepwithyourRequestforPurchaseApprovalandCheckRequisitionForm.Ifatripispaidby"OtherDepartment,"forexampleCommunityEducation,TitleI,Magnet,etc.,placeacheckmarkontheappropriatelineandwritetheprogramnameonthelineprovided.ThepaymentamountofaContractedProvider(CommonCarrier)isanegotiatedpricebetweentheschoolprincipalandthecarrier.

IfusingaContractedProvider(CommonCarriersuchasAnnettBusLines,Greyhound,etc.)usethelistdistributedbyTransportationandapprovedbyRiskManagement.IfthereareotherlocalschoolbuscontractorsthatarenotContractedProviders,approvalmustbesecured from Transportation/Risk Management before contracting with that company. (NOTE: The Contracted Provider's signatureverifiestheamountagreeduponfortherequestedservice.ThePrincipal'ssignatureindicatesthattheprincipalagreestopay theamount quoted by the Contracted Provider for this trip.)

Section IV -- PaymentCertification

Insertthename,address,vendornumberandFINofthecontractor.TheBookkeeper'ssignatureverifiestheaccuracyoftheinformationrecordedontheformby the Trip Sponsor. The Principal's signature approves payment of the field trip.

ForDistrictfundsuse,makesuretoenteryourPurchaseOrderNumber,GoodsReceiptNumberandTicketNumberonthisform.ThiswillhelpAccountsPayablepaythevendorinapromptmanner. Sendtheoriginal,completedformtoAccountsPayable,2ndFloor,1701PrudentialDrive(#3001).

For Internal Account Funds, follow the prescribed Internal Accounting procedures to make payment.

Field Trips Paid by Booster Organizations

PleaseseeSCHEDULINGANDPAYMENTOFFIELDTRIPSSPONSOREDBYBOOSTERORGANIZATIONSANDOTHERNON-SCHOOLORGANIZATIONS

procedures for required processing of these field trips.

IMPORTANT:THEGOLDENRODCOPYISTOBECALCULATEDANDFORWARDEDTOTHETRANSPORTATIONBUSINESSOFFICEIMMEDIATELYFOLLOWINGCOMPLETIONOFTHEFIELDTRIP.

REVISEDJULY2007

revised10/30/2012

Classroomand/orGroupInformationSheet(Step14)

InoraSurroundingCounty(Duval,Baker,Bradford,Clay,Nassau,St.JohnsorUnion)

FieldTrip:Date oftrip:

Teacher:Roomnumber:

Ifattendingfieldtrip,Teacher’sCellphone:(confidential,emergencyuseonly)

Thiscompletedinformationsheetistobeplacedontopofalltheclassroomstudent’ssignedParent/Guardian Consent Forms and all the signed Volunteer Chaperone Responsibilityforms,bandtogether,andplacedintheaboveteacher’smailboxbeforeleavingforthefieldtrip.

*Approved Chaperones attending field trip with Cell phone (all cell numbers are confidential andforemergency useonly):

Chaperone:Cell:

*Studentswhoareatschool(NOTattendingfieldtrip):

Student:w/Teacher:Rm#

*Studentswhoareabsent(NOTatschoolorattendingfieldtrip):

Student:Student:

*Ifmorespaceisneeded,usethebackofthisform.

Classroomand/orGroupInformationSheet

OUT-of-County Field Trip (Step14A)

FieldTrip:Date oftrip:

Teacher:Roomnumber:

Ifattendingfieldtrip,TeacherCellphone:(confidential,foremergencyuseonly)

Thiscompletedinformationsheetistobeplacedontopofalltheclassroom student’s signed Parent/Guardian Consent Forms and all the signedChaperone Volunteer Responsibility forms, then rubber band together, and placed inthe aboveteacher’smailboxbeforeleavingforthefieldtrip.

ApprovedChaperonesattendingfieldtripwithCellphone(allcellnumbersareconfidentialandforemergency useonly):

Chaperone:Cell:

StudentswhoareNOTattendingthefieldtripandareatschool:

Student:w/Teacher:Rm#

Students who areAbsent:

Student:Student:

FieldTrip—Out‐of‐CafeteriaMealsSOP

ImportantNotesforTeachersandCafeteriaEmployees:

•AcafeteriaemployeemustprovideaFieldTripBagLunchRequestform(page3)totheteacherforfieldtripdays.Thisformmustbecompletedandreturnedbytheteachertothecafeteriaemployeeatleasttwoweekspriorthefieldtripdate.ReturningthisformbytherequesteddatewillassistcafeteriaemployeesplanningandpreparingFieldTripmeals.

•ThecafeteriaemployeemustprovideaFieldTripTemperatureLog(page4)andathermometertotheteacheronthefieldtripday.Theteachermustreturnthecompleted,signed,anddatedFieldTripTemperatureLogandthethermometertothecafeteriaemployeeattheendoftheFieldTripday.

•Theteachermustprovideacoolerwherelunchesandthethermometeraretobeplacedin.LunchesmustbeplacedinthecoolerimmediatelyasthestudentsgothroughthePOS.

•ThecafeteriamanagermustverifythatallpertinentFieldTripdocumentationiscompletedandfiledwiththeendofdaypaperworkforthefieldtripdate.ThisdocumentationincludesthecompletedFieldTripBagLunchRequestform,thecompletedandsignedFieldTripTemperatureLog,andtheFieldTripLunchRecipe.

CountingandClaimingProcedures

•ThecafeteriawillprepareeachlunchaccordingtotheFieldTripBagLunchRecipe.

•AllFieldTripmealsarenon‐OVS(Offervs.Serve).Aunitizedbaglunchisprovidedtoeachstudentthatwishestoparticipate.ThisprogramisapplicableatallDCPSsites.

•Theseluncheswillcontain4componentspluseachstudentwillbegivenachoiceofmilk.

•EachstudentrequestingafieldtriplunchasrecordedontheFieldTripBagLunchRequestformprovidedtotheteacherbythecafeteriaemployeewillproceedtothecafeteriatopickupthelunch.

•AcafeteriaemployeewillprovideathermometerandaFieldTripTemperatureLogforthecoolerwhichmustbeusedtotakethetemperatureofthemilkbeforedistribution.

•CashierensureseachstudenthasareimbursablemealpriortoclaimingbyusingthecompletedFieldTripBag Lunch Request form from theteacher.

•TheStudent’sIDcardornumberisenteredatthePOSattheendoftheservingline.

•ThestudentisverballyidentifiedbynameatthePOS.

•The“AndJusticeforAll”posterwillbepostedandvisibleintheareawherethestudentsarereceivingthemeal.

•ThecompletedFieldTripBagLunchRequestformandcompletedFieldTripTemperatureLogmustbefiledwith theEndofDaypaperworkforthatdate.

•ThecafeteriamanagerisalwaysresponsibleforverifyingthattheFieldTripOut‐of‐CafeteriaMealsProceduresarefollowedaccuratelyandthatallfieldtrippertinentdocumentationisfiledproperly.

FieldTripBagLunchRequestForm

Allstudentscanorderabaglunchforafieldtrip.Lunchesmustbeplacedinacoolerbeforeleavingthecafeteria.Allstudents(Free,ReducedandPaid)canorderasacklunchforaFieldTrip.

Date oftrip

Homeroom Number#TeachersName

DaterequestedBagLunches (Must be at least two weeks prior to thetrip)

SchoolNameSchool#

Student ID#Student LastNameStudent FirstName

TeacherManager/EmployeeVerifyingMeals

FieldTripTemperatureLog(Step15)

SchoolNumberSchoolName

TeacherDate of FieldTrip

StatePolicydictatesthatwemustkeepmilkandfoodcold whileattendingfieldtrips.Wewouldask that you keep the lunches and milk in coolers until service time. Please record the temperature ofthe coolerjustbeforeservice.Pleasereturnthislogandthethermometertothecafeteriaorplaceinthe cafeteria manager's mailbox. We appreciate yourcooperation.

Your cafeteria manager can demonstrate how to take temperaturesproperly.

Item / Temperature / Printed Name and Initials ofAdult takingTemps
Cafeteria Manager sign whenreturned / Datereturned

PriortodepartingEVERYlocation,takeattendance.Anumbermaybeassignedtoeachstudent andchaperone,thena"call‐off"proceduremaybeutilizedtoexpeditetheattendanceprocess.

FIELD TRIP ATTENDANCE (Step16)

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FIELD TRIP ATTENDANCE (Step16)

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FIELD TRIP ATTENDANCE (Step16)

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