ICEMEN School Fieldtrip Form

STUDENT FIELD TRIP AUTHORIZATION FORM
Beachside High School

St. Augustine, FL
To participate in a school field trip or any activity that requires a field trip form, a student must secure the signature of each teacher whose class
he/she will miss. It is the student’s responsibility to secure all signatures before returning this form to the sponsoring teacher. The deadline for
completion of this form is two school weeks prior to the date of the trip. Failure to submit the completed form on time will result in the student not
being allowed to participate in the trip.
Name of Student ______________________________________________________________________________________________
Destination Jacksonville Icemen (300 A Philip Randolph Blvd, Jacksonville, FL 32202)
Purpose of Trip Jacksonville Icemen School Day Game
Date, time, and place of DEPARTURE Thursday, November 14, 2024 (9:30am)
Date, time, and place of RETURN Thursday, November 14, 2024 (1:00pm)
Type of transportation (check one)

School Bus Commercial Bus, Train, Plane X Private Vehicle _______Othe
r
PRINTED NAME OF SPONSORING TEACHER _____Jonathan Higgins
SIGNATURE OF SPONSORING TEACHER ________________________________________________________________________
SECURE TEACHERS’ SIGNATURES FOR PERIOD(S) MISSED

Comments
Module/ Name of Signature Permission (1--excessive absences)
Period Subject Teacher of Teacher for Trip (Y or N) (2--average below 70)
ST. JOHNS COUNTY SCHOOL BOARD PARENT RELEASE FORM

I understand that my son/daughter has requested to participate in this field trip. I/we have read the teachers’ recommendations and comments. I/we
understand that it is my/our child’s responsibility to make up any work that he/she misses during the time of the trip. The student must contact the
teacher prior to the trip to arrange for makeup work.
I consent to my child’s participation in the aforementioned field trip. I agree to release and discharge the St. Johns County School board, its officers,
agents, and employees, exercising reasonable care within their type of employment, from liability (all claims and demands/rights and causes of actions)
growing out of personal injuries and property damage resulting or occurring during the aforementioned activity, or in transit to and from said activity.
SIGNATURE OF PARENT OR GUARDIAN ____________________________________________________

DATE________________
My son/daughter has special medical needs _______________________________________________________________________
_____________________________________________________________________________________________________________
My emergency contact number for the day of the trip is ______________________________________________________________
ST. JOHNS COUNTY SCHOOL DISTRICT
PARENT PERMISSION FORM FOR FIELD STUDY ACTIVITIES
School: Beachside High School
I/We, the parents/guardians of the student named below, understand the nature of the activity being planned to:
Jacksonville Icemen (300 A Philip Randolph Blvd, Jacksonville, FL 32202 on November 14, 2024
(DATE)
Time: Leave: 9:30AM Return: 1:00 PM This field study includes a supervised water activity: Yes __ No X
SJCSD School Bus at a cost of $30.00

(MODE OF TRANSPORTATION)
We acknowledge our student is in good health and the study does not pose a health hazard to my student. We also understand in
times of national emergency or any other time when it is in the best interest of the health, safety and welfare of students and
employees, the School Board may revoke its approval assuming no liability for reimbursement of costs or expenses incurred by
the cancellation of any activity.
I/We hereby grant permission and give my/our consent for my student to (1) be treated by any qualified nurse, physician, or
surgeon as may be deemed necessary by the district, its agents, servants, or employees during the activity; (2) be administered
medication and/or emergency first aid care as may be necessary or appropriate; and (3) receive treatment in hospitals, medical
offices, or elsewhere in the event of accident or illness. To assist in that medical care or treatment, I/we represent that the medical
information supplied on the Medical Information Form and or the School Health Card is true and accurate. The district, its agents,
servants, or employees are not responsible for acts or omissions of third parties as a result of securing medical care. I/We will hold
the district and its agents, servants, or employees harmless and indemnify them from any claim, cause of action or demand arising
out of any form of or the lack of medical or emergency treatment rendered to my student.
In the event that a student must return to school independently for reasons of health, accident, failure to conform to rules
established by the teacher in charge, etc., we agree to accept full responsibility for and to pay for the cost of medical care,
transportation and other incidental expenses. This permission slip also serves as a contract that the student and parent(s)
understand and agree to the guidelines from each teacher as to making up missed assignments.
My student, by his/her signature hereto, fully agrees and consents to the foregoing with permission to participate in the listed field
study.
Student’s Name (Print): ______________________________________________
_______________________________________________________ ____________________________
Signature of Student Date
My student requires medication and/or medical attention: YES ____ NO ____
If yes, you must complete the Medical Information Form (obtained from the activity supervisor) and provide the medication to the
personnel trained to administer the medication.
S
_______________________________________________________ _____________________________
Signature of Parent/Guardian Date
________________________ ______________________ _____________________________

Cell Phone Work Phone Home Phone
Emergency contact, if parent unavailable _____________________ Phone _______________________
Family Physician ________________________________________ Phone _______________________
Health Insurance Provider _________________________________ Policy# ______________________
Board Approved 8.12.14 (Revised October 2018)

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STUDENT FIELD TRIP AUTHORIZATION FORM

Beachside High School

Name of Student ______________________________________________________________________________________________

Destination Jacksonville Icemen (300 A Philip Randolph Blvd, Jacksonville, FL 32202)

Purpose of Trip Jacksonville Icemen School Day Game

Type of transportation (check one)

PRINTED NAME OF SPONSORING TEACHER _____Jonathan Higgins

SIGNATURE OF SPONSORING TEACHER ________________________________________________________________________

SECURE TEACHERS’ SIGNATURES FOR PERIOD(S) MISSED

ST. JOHNS COUNTY SCHOOL BOARD PARENT RELEASE FORM

SIGNATURE OF PARENT OR GUARDIAN ____________________________________________________

School: Beachside High School

SJCSD School Bus at a cost of $30.00

Student’s Name (Print): ______________________________________________

My student requires medication and/or medical attention: YES ____ NO ____

________________________ ______________________ _____________________________

Emergency contact, if parent unavailable _____________________ Phone _______________________

Family Physician ________________________________________ Phone _______________________

Health Insurance Provider _________________________________ Policy# ______________________

Board Approved 8.12.14 (Revised October 2018)

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My student requires medication and/or medical attention: YES NO

_______

Emergency contact, if parent unavailable _ Phone ___

Family Physician __________________ Phone _

Health Insurance Provider ___________ Policy#