Holocaust field trip
Hi, some students wanted me to post the text of the field trip permission slip online. This is due tomorrow for 7th grade. If it does not make it home, please copy the text below and print it out. Thanks so much! I think it will be a very interesting field trip leading us into reading about Anne Frank.
I can drive Name: ________________ Phone #:
_________________ My car holds
_________ (excluding you)
_____________________________ ___________________________
7th
Grade trip -- Legal Guardian Permission
Dear Parent or Legal Guardian:
Your son/daughter/guardianship has been selected
to participate in a school sponsored activity that requires transportation to a
location away from the school site. This
activity will take place under the guidance and supervision of employees from
Sacred Heart School. A brief description
of the activity follows:
Curriculum Goal: Discuss the power of persuasion and connect
back to persuasive writing, propaganda in the modern world, and our quarter two
reading about Anne Frank
Destination: We are
going to the National Archives (400 W. Pershing Road, KC MO) for the “State of
Deception: The Power of Nazi Propaganda” presented by the Midwest Center for
Holocaust Education and produced by the U.S. Holocaust Memorial Museum
Designated Supervisor of Activity: Sarah Rajewski
Date and Time of Departure: October 21st at 8:30 – We might be
a little early, but you never know with traffic!
Date and Time of Return: Oct. 21st around 1 p.m. If it is
nice out, we will stay for lunch and eat outside. If it is cold or rainy, we
will bring our sack lunches back to school and eat in the classroom. PLEASE do not order a school lunch this
day. We might not be back.
Method of Transportation: Parent
transportation – If you can drive, please see below!
Student Cost: Free. Students will need to bring a sack
lunch.
--------------------------------------------------------------------------------------------------------------------------------------------------------------
I can drive Name: ________________ Phone #:
_________________ My car holds
_________ (excluding you)
*If you can
drive, I need you to fill out the back of this form too.
Email address:
_____________________________________________________________________________________
If you would like your child to participate in
this event, please complete, sign and return the following statement of consent
and release of liability. I understand that as a parent/legal guardian, I remain
legally responsible for any personal actions taken by the above named minor
participant. I agree on behalf of myself, my child named herein, our
heirs, successors and assigns to hold harmless and defend Sacred Heart in
Shawnee, Kansas, the Archdiocese of Kansas City, and their officers, employees,
volunteers, chaperons, agents and representatives associated with this
activity, from any claim arising from or in connection with my child attending
the activity or in connection with any illness or injury (including death) or
cost of medical treatment resulting from the activity; and further, I agree to
compensate the parish/school and the Archdiocese, their officers, employees,
volunteers, chaperons, agents and representatives associated with this activity
for reasonable attorney’s fees and expenses which may be incurred in any action
brought against them as a result of such injury or damage, unless such claim
arises from the negligence of the parish/school/archdiocese. To the best of my knowledge, my child is in
good health and is physically able to participate in this activity. I assume all responsibility for the health of
my child. I hereby consent to participation by my child in
the event described above. I understand
this event will take place away from school grounds and my child will be under
the supervision of the designated school employee(s) on the stated dates. I further consent to the conditions stated
above on participation in this event, including the method of transportation.
________________________ _________ ___________________ _______________________
Signature of Parent/Guardian Date Emergency Phone
Number Address
I hereby authorize Sacred Heart Catholic School
to take my child for medical treatment in the event of an emergency in which
neither parent can be reached. I
authorize any licensed physician or medical center to treat my child.
_____________________________ ___________________________
Signature of Parent/Guardian Date
SCHOOL SAFETY
FIELD TRIP
(DRIVER INFORMATION SHEET)
DRIVER
NAME
__________________________________ Date
of Birth ______________________
Address __________________________________ Social Security # ___________________
__________________________________
Driver’s License #__________________________ Date of
Expiration __________________
VEHICLE THAT WILL BE USED
Name of Owner ___________________________ Model
of Vehicle ___________________
Address ___________________________ Make of Vehicle ____________________
License Plate ___________________________ Year of Vehicle _____________________
Registration
Date of Expiration _________________________ Expiration Date _____________________
If more than one vehicle is to be used, the aforementioned
information must be provided for each vehicle.
INSURANCE
INFORMATION
When using a privately-owned vehicle, the insurance coverage
is the limit of the insurance policy covering that specific vehicle.
Insurance Company
__________________________________________________________
Policy # ___________________________ Expiration Date __________________________
Liability Limits of Policy*
_____________________________________________________
*Please note: The minimal, acceptable liability limit for
privately-owned vehicles is $100,000/$300,000.
CERTIFICATION
I certify that the information given on this form is true
and correct to the best of my knowledge.
I understand that as a volunteer driver, I must be 21 years of age or
older, possess a valid driver’s license, have the proper and current license
and vehicle registration, and have the required insurance coverage in effect on
any vehicle used to transport students.
___________________________________________________________________________
Signature Date
Form
#C115e
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