Student Field Trip And Class Excuse Form
Date:
Name: Team:
Trip Date:
Destination:
Purpose of Trip:
**Cost: Adm.: Bus: Other: Total:
Time of Departure: Return: Type of Transportation:
Signature of Person Making Request
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PARENTS – PLEASE NOTE: FOLLOWING FIELD TRIPS ARE NOT MANDATORY.
PLEASE TAKE INTO CONSIDERATION THE ITEMS BEFORE GRANTING PERMISSION.
1. Purpose of the trip
2. Your child’s school attendance
3. The above teacher comments
4. The child’s academic status
5. The number of field trips planned for your child
PARENTS – PLEASE DO NOT SIGN THIS FORM IF YOU FEEL YOUR CHILD SHOULD
NOT MISS A DAY OF CLASSES FOR THIS ACTIVITY.
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PARENT RELEASE FORM
I/We consent to ______________________________ going to :
(Student Name) (Destination)
on for supervised activities, and agree to release and discharge the
(Date)
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 of occurring during the aforementioned activity, or in transit to and from said activity.
Dated: ______________________ _______________________________
Parent or Guardian Legal Signature
Chaperone information on the back of this form. Only fill it out IF
you are planning on chaperoning the field trip.
Beginning August, 2005 the Duval County Public School Board requires ALL chaperones/volunteers to
complete a Volunteer Application. The applications may be picked up at any DCPS or pulled off their
website: educationcentral.org. If an application is not on file, you cannot participate in any school
function. Please understand! This is for the safety of ALL of our students who may have contact with any
adult.
Mandarin Middle School Student Field Trip Responsibilities
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1. Be prompt and prepared for all activities.
2. Check in with your advisor or chaperons at all designated times and places.
3. Adhere to the dress code at all times.
4. Abide by the MMS Code of Conduct, which is in effect at all times.
5. Remember that you are representing Mandarin Middle School, yourself and your family at all
times.
6. NO SWIMMING IS ALLOWED on any field trip.
VIOLATING ANY OF THESE RESPONSIBILITES WILL RESULT IN IMMEDIATE DISCIPLINARY
ACTION.
“I have read and fully understand the above Field Trip Student Responsibilities and agree to comply with them.”
________________________ _____________________________________
Date Student’s Signature
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Mandarin Middle School’s Chaperone Responsibilities On Field Trips
The following list identifies your responsibilities as a chaperone when accompanying students on Mandarin Middle
School field trips. If you are interested in chaperoning this field trip, please review the list, sign, and return to your
child’s teacher with your payment, if applicable.
Must be a parent/guardian of the student going on this field trip.
No children except for those in the participating class or group may attend this field trip.
Must 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.
Only school personnel will administer medications to students. Fill this section out (MMS’
Follow assigned agenda of activities. Chaperone Responsibilities On
No tobacco or alcoholic beverages are permitted on field trips. Field Trips)
NO SMIMMING IS ALLOWED on any field trip.
IF you intend to chaperone this
IMMEDIATELY report ANY PROBLEMS directly to the teacher.
field trip!
Arrive promptly for departure of trip .
________________ _______________________________________
Date Parent/Guardian Signature
Chaperone Cost:Adm.: ____ ______________________________________________________
Bus: ____ Student’s Name (Please print)
Other: ____
Total: ____
CASH or MONEY ORDER ONLY! ____________________________ _______________________
Daytime Telephone # Evening Telephone #