CALIFORNIA'S FUTURE LEADERS

PARENT'S OR GUARDIAN'S PERMISSION FOR A FIELD TRIP AND AUTHORIZATION FOR MEDICAL CARE - IV.D. TRIP SLIP
To the Principal of Bert Corona Charter High School my child

has my permission to participate in the following field trip:

Field trip location: Wednesdays - Boys and Girls Club - 11251 Glenoaks Blvd, Pacoima, CA 91331 Fridays - Monte Verde Equestrian Center 11035 Osborne St, Kagel Canyon, CA 91342 10/15-12/12 Depart 4:30 PM Return: 6:30 PM

Supervising Staff: Mr. Pelayo

Method of Transportation: Walk to Boys and Girls Club, Boys and Girls Club Van to ranch
Student Name*

First NameLast Name
Signature*

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Date*

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Authorization for Medical Care

Should it be necessary for my child to have medical care while participating in this trip, I hereby give the School District personnel permission to use their judgment in obtaining medical care for the child, and I give permission to the physician selected by the School District personnel to render medical care deemed necessary and appropriate by the physician. I understand that the District carries minimal ($1,500) excess student accident insurance for one day field trips which are conducted under the constant, direct and immediate supervision of designated school authorities and that injuries sustained while not under direct and immediate school supervision is not covered. I also understand that for field trips where constant, direct and immediate supervision isn't possible, the District requires students to be insured under separate, "Short Term 24-Hour" coverage.
Student Name*

First NameLast Name
Home Address*
Home Telephone No*
Business Telephone No
Emergency Telephone No*
Authorized Signature of Parent or Guardian*

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Parent or Guardian's Name*

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Date*

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Date
PLEASE CHECK HERE IF INSTRUCTIONS FOR SPECIAL MEDICAL TREATMENT FOR THE STUDENT ARE ON FILE IN THE SCHOOL
PLEASE NOTE:

Section 35330 of the California Education Code states in part: "All persons making the field trip shall be deemed to have waived all claims against the District or the State of California for injury, accident, illness, or death occurring during or by reason of the field trip or excursion". Accident insurance can be purchased for a minimum daily rate by contacting the school. This institution is an equal opportunity provider.
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