Bus # Modesto High School PARENTAL AUTHORIZATION FOR STUDENT TO PARTICIPATE IN SENIOR TRIP 2018 has my permission to attend the senior trip, which will take (Name of Student) (ID #) place at: California Adventure and Disneyland Anaheim/Orange County (Facilities) (Location/City) Date of Event: Sunday, May 20, 2018 Time of Departure: 4:45 a.m. Sunday, May 20, 2018. Time of Return: 9:00 a.m. Monday, May 21, 2018 (approx.). Teacher or Leader: MHS Administrator and staff chaperones (2 per bus). Method of Transportation: Charter buses I understand that all students going on this trip will conduct themselves in accordance with Modesto City Schools Student Conduct Code. It is further understood that students will go and return from the event in the transportation provided. I, the undersigned parent/guardian, assume financial responsibility should the above-mentioned student have to return to Modesto prior to the end of the trip. I understand that Education Code Section 35330 provides in part, as follows: All persons making the field trip or excursion 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. The TOTAL COST of the trip is $310.00. Your seat is NOT guaranteed until full payment has been received. On or before March 1, 2018, a non-refundable deposit of $160.00 must be received to reserve a seat on the bus. The remaining $150.00 balance is due on or before Friday, April 13, 2018. Students are given the opportunity to raise funds through established senior trip fundraisers which are available in the Student Body Office. If you are fundraising, your initial deposit will be made with your first fundraiser in February. Money raised through fundraising will not be refunded to the student, but will revert to the senior trip account. Once the trip reaches capacity, a wait list will be started. REFUND POLICY: Contractual obligations with the travel company do not allow for refunds. This includes ineligibility, illness or family emergencies that may arise even on the day of the trip. If the student is not able to attend after payment has been made, it may be possible for the student to sell their spot to another eligible senior on the waiting list by 4/23/2018, but that is not guaranteed. Neither refund nor exchange is authorized for passengers who miss the scheduled departure. ELIGIBILITY: Students MUST be eligible to attend the senior trip. Students who have debts to the school, 2 or more U s {3 rd Quarter}, 5 or more unexcused absences, 6 th step truancy or 1-2 home suspensions totaling 4 days in the second semester, are NOT eligible to attend the senior trip and will forfeit their spot with NO REFUND!!. All requirements are listed in the 2017-2018 MCS Student Code of Conduct. MEDICATION: All medication (i.e., prescription or over the counter) must be given to the chaperone prior to leaving on the trip. It will be held by the chaperone though-out the trip and given to the student as necessary. I have read and understand the above contractual obligations, refund policy and eligibility information. I give permission for my student to attend and to pay non-refundable fees for his/her senior trip. Date: (Parent or Guardian Signature) (Student Signature)
MODESTO CITY SCHOOLS Risk Management Department 426 Locust Street, Modesto, California 95351-2699 (209) 550-3300 ext 5471 (209)550-3485 fax RELEASE AND INDEMNIFICATION I,, (Name of Parent/Guardian) do understand and hereby agree to release, indemnify, save and hold harmless Modesto City Schools (District), (Name of School), and their employees, officers, agents, and volunteers, from any and all liabilities, claims, and causes of action that may arise--including IF the bus company contracted by the District fails for any reason to pick-up (and transport) my Senior Student (Name) to the specific destination of the Senior Trip. Further, I understand that if the bus company contracted by the District fails to arrive and pick-up my Senior Student, it will make every effort to hire a replacement bus company, subject to the time constraints of the Senior Trip itself. Finally, the District does not guarantee (nor does it represent) that a make-up replacement trip to the destination of the Senior Trip will occur if no replacement bus company is found. I acknowledge that I have carefully read this RELEASE AND INDEMNIFICATION FORM and that I have understood and agreed to its terms. Signature of Parent/Guardian: Date: Printed Name: Signature of Student: Date: Printed Name: RM-10/2016 (Sr.Trip)
IMPORTANT SENIOR TRIP DATES Contract must be completed and turned in to make a deposit or to fundraise. All deposits and payments are non-refundable and based on availability. You must have your ID card to make payments in the Student Store. Jan. 16 th March 1 st Feb 1 st March 1 st March 9 th April 13 th Fundraising period Come to Student Store to sign up for fundraising and to receive products to sell. Non-refundable deposit of $160 (or total cost of $310) and completed contract to reserve/guarantee a seat. All Fundraising money or unsold items due to Student Body Office. Total balance of $310 due. Late payments will not be accepted. Students failing to pay the entire trip fee by Friday, April 13 th by 3:00pm will be replaced by a student on the waiting who has paid in full. IMPORTANT NOTES No Refunds: Fundraisers: Payments Accepted: Eligibility: Unfortunately, your seat is paid for whether you go or not. See the Student Body Office for more info. You must have a fundraising permission slip on file in the Student Body Office prior to fundraising. Participating in fundraising DOES NOT reserve your spot on the bus until an actual deposit is made onto your account. Before school, after school and at lunch only. Payments will only be accepted until 3:00 p.m. Deadlines are firm no late payments accepted. Cash, Check, VISA, Master Card, American Express, Discover, & ATM are accepted. Remit checks to MHS Senior Trip and put your ID number on the memo line to ensure accurate credit to your account. All participants must be eligible based on 3 rd quarter grades and citizenship. See conduct code for more info.
Tentative Trip Itinerary Subject to Change Sunday May 20, 2018 4:00 am Meet Modesto High School 4:45 am Depart Modesto High School Rest Stop Arrive Bakersfield/Grapevine Area 12:30 pm Arrive Disneyland Resort Enjoy Disneyland / California Adventure Monday May 21, 2018 12:00 am Meet Disneyland Parking Lot 1:00 am Depart Disneyland 9:00 am Arrive Modesto High School Final arrival times are approximate. *Remember-You are responsible for food and spending money!* Final details will be reviewed at the Senior Trip Meeting On April 20, 2018 in the Auditorium!
MHS ASB CLUB PERMISSION SLIP Consent for Participation in Modesto City Schools Associated Student Body Organization has permission to participate as a member of the Student s Name Senior Class 2018 at Modesto High School for the 2017-2018 school year. Student Body Organization A copy of the organization s constitution is on file and available for inspection in the Student Body Office. Parent/Guardian Signature Date SENIOR TRIP FUNDRAISER PARTICIPATION CONSENT I give permission for my child to participate in fund raising activities sponsored by the club under the guidelines set forth by the Associated Student Body. I understand I/my child will be financially responsible for items released to them for sale and any funds they are to collect. Parent/Guardian Signature Date Student Signature Date
MODESTO CITY SCHOOLS Exhibit E 6153 E MODESTO CITY SCHOOLS PARENTAL DELEGATION OF AUTHOORITY TO CONSENT TO MEDICAL OR DENTAL TREATMENT FOR MINOR CHILD (CIVIL CODE SECTION 25.8) (EXTENDED DAY, OVERNIGHT, OUT OF STATE/COUNTRY) To: Modesto High School We, the undersigned are the parents/guardian of, Birthdate, a minor, or I, the undersigned, am the sole parent having legal custody of said minor, or I, the undersigned, am the legal guardian, pursuant to order of the court, of said minor. We, or I, hereby authorize any adult into whose care said minor has been entrusted to consent to X-ray examination, anesthetic, medical, surgical, or dental diagnosis, or treatment and hospital care upon the advice of a physician, surgeon, or dentist licensed under the Medical Practice Act or Dental Practice Act. Child s Blood Type: Child s Medication Allergies (if any): Special Instructions/Health Problems: Date Signed: (Father, or Legal Guardian, if any, Signature) City: (Mother s Signature) (Witness Signature)
MODESTO CITY SCHOOLS Exhibit E 6153 B MODESTO CITY SCHOOLS PARENTAL AUTHORIZATION FOR STUDENT TO PARTICIPATE IN DISTRICT APPROVED FIELD TRIP WITHIN STATE OF CALIFORNIA has my permission to attend (Name of Student) Senior Trip which will take place at California Adventure and Disneyland Anaheim, CA (Facility) (Location/City) Date of Event: May 20-21, 2018 Class/Group Attending: Senior Class of 2018 Time of Departure: 4:45 a.m. on 5/20/18 Time of Return: 9:00 a.m. on 5/21/18 Teacher or Leader: Brad Taylor Method of Transportation: STORER Coachways If Traveling by Automobile, Name of Driver : I understand that all students going on this trip will conduct themselves properly, be responsible to the bus driver, to teachers, and adult sponsors. It is further understood that students will go and return from the event in the transportation provided. (Parent/Guardian Signature) (Date)