Return completed form and payment to Mr. Neill in room 318
SenecaValleySchoolDistrict
TracyL.Vitale, Ed.D.
SuperintendentofSchoolsAdministration Center
124SenecaSchoolRoad
Harmony, PA 16037-9134
PHONE:(724)452-6040
FAX:(724)452-6105
FIELD TRIPPERMISSIONFORM
Student’s Name: Student Cell Phone # Date(s)ofFieldTrip: _June 5, 2018 ____ Depart: __6 AM____Return: 9 PM
NameofOrganization/ Class:PhysicsCostof FieldTrip:$95plus breakfast, non-refundable_
PurposeofFieldTriporActivity: Study the physics of amusement park rides at Cedar Point______
Period / Teachers Signature / Yes,workcanbecompletedprior to/followingthis activity / No,Workor
class activity cannotbe rescheduled / DescriptionofActivity
1
2
3
4
5
6
7
8
9
Pleasehave your parent/guardianreviewthisformandhave allthe requestedinformationcompleted before yourequesttheir signature ofapproval.
Myson/daughterhasmypermissiontoparticipateinthefieldtrip
To Cedar PointonJune 5, 2018atacostof $ __95.00 _ non-refundable _
I understandthatmyson/daughterwillberesponsible forall classworkassignedorcompletedonthisdateand thatallstudentparticipantsaresubjecttoallSchool Districtpolicies andprocedures.
Signature of Parent/Guardian:Date:
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FieldTripMedicationForm
Schoolhealthpersonnelaregenerallynotinattendance onfieldtrips.Medicationandtreatmentsshouldbe administeredprior todeparture oruponreturntoschoolwhenever possible.If astudent requiresmedication
ora treatmentinordertoparticipateintheprogram,theschoolnursewillassistwithplanningfortransportof the appropriatedoseofmedicationorequipment.Thestudentwillbeprovidedwiththe opportunitytoself-administer
the medicationorperformthetreatmentatthedesignatedtime.If thestudentisunabletoself-administerthe
medicationortreatment,thestudent’sparentwillbeinvitedtoattendthefieldtrip.
Pleasecompletethefollowingif yourchildreceivesa medicationortreatmentatschoolonadailyor“asneeded” basisthatwillberequiredduringthefieldtrip.
willrequire
Name of StudentMedicationorTreatment
whileparticipatinginthisprogram
Signatureof Parent:
FIELDTRIPINFORMATION
TheSenecaValleySchoolDistrictrecognizes thevalueandencourages theopportunitiesforstudents toparticipateinpre-plannedfieldtrips andeducationalexperiences duringthe regularschoolyear.The pre-approvalformonthebackofthis sheetmustbe returnedtotheschool-approvedadultsupervisor priortothis trip.
Ifaproposedtriphas beenapprovedbytheprincipal,writtenpermissionfromaparentorguardian mustbeobtained.This permissionmustindicateunderstandingofthedate,time,cost(ifapplicable) andpurposeofthis trip.Pupilparticipants aresubjecttothesupervisionoftheschool-approvedadults, whomayrequireadress codefortheoccasion.Atalltimes theschoolcodeofconductwillbe enforced.
Thefacultymustreceiveatimelylistofparticipants approvedforthis educationaltrip.Students who areabsentfromanyoftheirregularly scheduledclasses becauseoftheirinvolvementinafieldtrip mustfollowtheseprocedures:
1.Formonreversesidemustbecompletedpriortothefieldtripandreturnedtothesponsorofthe fieldtrip.Students whofailtoreturnthis completedformmaynotparticipateintheactivity.
2.Students areresponsiblefornotifyingtheirteachers thattheywillbemissingclasses and completingallworkthatismissed.Thismustbedonepriortotheplannedabsence.
3.Becausefieldtrips andspecialactivities arevaluableeducationalexperiences,classroomteachers shouldattempttoaccommodateandsupportstudentparticipationintheseactivities.Iftheplannedclass activities thatastudentwouldmiss toparticipateinthefieldtripcannotbecompletedearlyor followingthetrip(ex:labexperiments ordemonstrations,groupreports,etc.),thestudentis tobe notifiedofthis typeofclassroomactivityatthetimehis/herfieldtriprequestis presentedtothe teacher.Thestudent,withtheassistanceofthesponsoroftheactivityandthestudent’s parent/guardian, mustevaluatetheappropriateness ofhis/herparticipationinthefieldtriporspecialactivitybasedon thisinformation.
4.Parentalapprovalforastudenttomiss classroomactivities toparticipateinafieldtriporspecial activityisindicatedbythesignatureofthestudent’s parent/guardianonthebottomofthecompleted form.
5.Astudentwithexcessiveabsences willnotbepermittedtoattendschoolsponsoredfieldtrips or activitiesiftheactivities requireadditionalabsencesfromregularly scheduledclasses.