Henry County Schools

Field Trip Procedures

10.06.2017
 Henry County Schools Field Trip Procedures

TABLE OF CONTENTS

I. Introduction and definitions.... 1

A. Board policy
B. Field trip definition

II. Description of field trip activities & administrative approval process... 1

A. Description of field trip activities
B. HCS administrative approval process

III. Risk identification and documentation .. 3

A. Identify and assess risks
B. Be familiar with facilities and equipment
C. Determine student medical needs
D. Comply with medication procedures

IV. Supervision and chaperone selection .. 3

A. Supervise students at all times
B. How many and what kinds of chaperones are needed
C. Volunteer chaperone selection

V. Transportation .... 4
A. District school bus
B. Charter bus
C. Private vehicle
D. Walking
E. Air transportation
F. Other means of transportation

VI. Overnight field trips - housing .. 7

A. Arrangements
B. Supervision
C. Inspection
D. Providing information to parents/guardians

VII. Parental information and consent.. 7

A. Inform parents/guardians
B. District policies apply
C. Related documents

VIII. Student preparation & chaperone training . 9

A. Pre-trip training for both students and chaperones
B. Clothing and equipment
C. Valuables and money
D. Student Behavior Agreement
E. Chaperone responsibilities and training
 Henry County Schools Field Trip Procedures

F. Emergency communication
G. Access to student health information
H. Distribution of medications

IX. International field trips .. 12

A. School board approval
B. Use of outside sponsoring groups
C. Information about foreign countries
D. Land Transportation
E. Air transportation
F. Housing
G. Insurance outside of the U.S.
H. Informational meetings for students and parents

X. Appendices-Forms and HCS Policy 17

Appendix A FT-1 Field Trip Description and Itinerary

Appendix B FT-2 Field Trip Behavior and Expectations Student
Agreement
Appendix C FT-3 Non Athletic Co-Extra-Curricular Permission Slip
Form A
Appendix D FT-4 Parent/Guardian Field Trip Permission/Emergency
Information Informed Consent Form
Appendix E This Page Intentionally Left Blank
Appendix F FT-6 Volunteer Background Check Process
Appendix G FT-7 Guidelines for Volunteer Field Trip Chaperones
Appendix H FT-8 Notification to School System Volunteer Obligation as a
Mandated Reporter for Suspected Child Abuse
Appendix I FT-9 Volunteer Driver Checklist
Appendix J FT-10 Field Trip Self Transportation Release
Appendix K FT-11 Liability Notice for Employee or Parent Volunteer
Transporting Students Form B
Appendix L FT-12 Pre-Approved Field Trip Request Form
Appendix M FT-13 Non Pre-Approved Field Trip Request Form
Appendix N FT-14 Athletic Non-Pre-Approved Field Trip Request Form
Appendix O IFBGA Henry County Schools Electronic Use Policy
I. Introduction & definitions

The purpose of these procedures is to help ensure the safety of all students, staff
and volunteers.

A. Board policy

These procedures supplement the school districts related policy (i.e.)

(IFCB). Field trip organizers must refer to and comply with all applicable
school district board policies and procedures.

B. Field trip definition

A field trip occurs when students leave school grounds for an

educational purpose. All school trips are considered an extension of the
school and as such, students on these trips with be expected to follow
school rules. No; fighting, bad language, physical intimacy, or rough
housing.

Types of field trips include:

Day field trips in state

Day field trips out of state
Overnight field trips in state
Overnight field trips out of state
Recurring field trips (same activity on a regular basis, such as a choir
or sports games)
International field trips

II. Description of field trip activities and administrative approval process

A. Description of field trip activities

A full description of the proposed activity will include the following:

1. School and sponsoring staff member(s).

2. The educational purpose/benefit of the activity.
3. Detailed information on the activities in which the students will be
participating (it answers who, what, when, where, why, and how).
a. The date and time of the trip
b. Where the trip will be to/from
c. Estimated number and ages of students to attend field trip
d. Related brochures/information provided
e. Any special exposures or any unusual aspects of the trip
identified including, but not limited to:
swimming, boats, or in/around water
 remote locations/hiking
animals
outdoor education
air travel
motorized activities
f. Means of transportation identified (school bus preferred)
g. Means of housing identified (if applicable)
h. Estimated number of chaperones needed, listing any special
qualifications for chaperones
i. Estimated costs and funding source(s)
j. A preliminary trip itinerary
k. Provide alternative to field trip for students not attending
l. Student health related information and medication
requirements
m. Any other special student needs

B. Administrative approval process

1. Purpose of administrative review

a. Field trips provide a valuable educational benefit. However, off-

site situations can expose students to hazards that are not
present in the normal school environment. As a result, it is
important for administrators to carefully review and monitor field
trips to ensure that risks and potential school liability are
minimized.

2. Principals/administrators should do the following:

a. Determine the appropriateness of activities for the students

age(s), skill(s) and behavior level(s).
b. Assist the sponsor with specific field trip risk identification.
c. Review and/or sign related contracts with Executive Officer
before submitting field trip request.
d. Obtain or provide certificates of insurance related to
contractual agreements and/or facility use.
e. Provide preliminary administrative approval for the field trip.
f. Submit the field trip to the Superintendent and/or Executive
Officer for approval.
g. Continue to follow up with the sponsor to ensure appropriate
actions are being taken.
III. Risk identification and documentation

A. Identify and assess risks.

B. Be familiar with facilities and equipment.

C. Determine student medical needs.

D. Comply with medication procedures.

IV. Supervision and chaperone selection

A. Supervise students at all times

Ensure supervision of students by an adult at all times. Remember the

rule of thumb about supervision - if you cant see the students, you are not
supervising them. Staff and chaperones must exercise close control over
the students. Students on field trips can become overly excited and want
to explore on their own.

Establish a process for regular accounting for all students and staff, both
periodically and when activities change (such as before boarding the bus
to return).

B. Determine how many and what kinds of chaperones are needed

throughout the trip.

Determine what supervision (what kind and how many) is needed.

Establish the proper ratio of supervisors to students based on a case-by-
case evaluation of each field trip. Be sure to follow school district policy.

1. Base the number of chaperones on an evaluation considering the

number of students, age and maturity of the students, types of
activities, facilities, duration of trip, type of transportation, and safety
considerations (such as emergency procedures).
2. There should be a minimum of two adults supervising a field trip. If not
specified in school district policy, recommended minimum supervision
ratios (adults to students) are as follows: elementary students1:15;
middle/high students 1:20. The building administrator and sponsor
should agree if additional supervision is needed based on an individual
field trip plans.
3. More and/or specifically qualified chaperones/staff may be needed for
higher-risk activities, overnight stays (gender-specific), activities
involving water (lifesaving) or wilderness (survival), out of country
travel (speak the language), and those including behaviorally,
physically or mentally challenged students.
 4. When the student group is co-educational, there shall be at least one
(1) chaperone of each sex. On all such overnight out-of-country K-12
students shall be accompanied by chaperones in accordance with the
following formula:
10 students or fewer- minimum two (2) chaperones;
11 to 20 students- three (3) chaperones;
Additional chaperone as need to maintain ratio of elementary
students 1:15; middle/high students 1:20.

5. First aid/CPR-trained chaperones/staff is preferred.

6. If the field trip is part of a classroom educational experience, sporting
event, or sponsored club, at least one certificated staff member is
needed.
7. For supervision purposes, each bus should have at least one staff
member or chaperone other than the driver.

C. Volunteer chaperone selection

Ensure that all volunteer chaperones are:

At least 21 years old
Background check as specified in HCS Volunteer/Chaperone Policy
Physically able to do the job
Able to work well with students
Meet any other criteria as set forth by HCS

If a volunteer chaperone will drive, have him/her complete FT-10 Liability

Notice for Employee or Parent Volunteer Transporting Students Form B.

V. Transportation

As field trips are off school grounds, transportation is normally needed. This can
be provided using a variety of forms. Listed below are transportation options and
issues related to each.

Be sure to specify the means of transportation in form FT-1 Field Trip Description
with Itinerary and/or form FT-3 Parent/Guardian Field Trip
Permission/Emergency Information/Informed Consent Form.

A. District school bus

This is the preferred means for transportation for several reasons: it is the
safest means of transportation, it is the easiest way to supervise many
students, school bus drivers are trained school employees, and using
district-owned and operated school buses keeps the money used for
transportation in the school district.
 To secure a school bus and driver for your trip log on to the electronic field
trip request form from the following link; http://hdctrans3/edulog/eFT/.
Once the trip is submitted, Transportation will schedule the school bus and
assign a bus driver. Email communication will be sent confirming this
process.

B. Charter bus

If school buses are not available, a recognized charter bus service can be
used as approved by Henry County Transportation Services. Please
consult with Transportation Services for more guidance.

C. Private vehicle

The use of private vehicles is not recommended, because the school does
not have control over private vehicles. Because of the lack of control, the
school will need to make efforts to ensure the safety of its students while
riding in private vehicles. These efforts include:

1. Volunteer driver selection and screening

Ensure volunteer drivers:

Complete Form B
Are at least 21 years old
Have a valid drivers license
Understand that the vehicles liability insurance is primary
Have received a copy of form FT-7 Guidelines for Volunteer
Field Trip Chaperones
Are provided all relevant field trip information

2. Vehicle insurance

Private vehicle drivers should provide proof of current vehicle

insurance. Administrators are required to make a copy of such
insurance and retain in records.

3. Specific parental permission

When students will be transported by adult volunteer drivers,

written parental permission to ride with a designated volunteer
driver must be obtained from all students who will ride with the
volunteer drivers. Complete FT-11 Liability Notice for Employee or
Parent Volunteer Transporting Students - Form B
 4. Student driving themselves and other students

a. If students will drive themselves, the students parent/guardian

must give specific written permission.
b. If students will drive other students (which is strongly
discouraged), volunteer driver requirements and vehicle
insurance and inspection (as above) must be followed. Specific
written parental permission from both the drivers and the riders
parents must be obtained. The Henry County School District
strongly discourages students from riding with other students to
and from extracurricular events and to this end, district
employees shall not assign students to ride with other students.

5. Parent provided transportation

a. A parent/guardian may elect to transport their student to and/or

from the field trip. If the student is transported via means other
than arranged by the school, the parent/guardian must release
the District from any and all liability that may arise as a result of
this alternate means of transportation.

b. Form FT-10 Self-Transportation Release Form may be used for

this purpose. For some non-curricular events (such as clubs),
the school may require students to provide their own
transportation to and from the activity. To reduce liability to the
school district in the event of a loss during parent provided
transportation, school staff should take no role in such
arrangements.

E. Air Transportation

Commercial airlines are often used when traveling long distances. Any air
travel other than by commercial airline should reviewed by the districts
Executive Officer in consultation with the Risk Manager. Remember that
air travel is traditionally excluded from school district insurance coverage.
The flyer may want to purchase additional insurance.

F. Other means of transportation

1. City bus Requires closer student supervision and designated money

handling procedures.

2. Train Railroad liability would be carried by the railroad and not a part
of school district insurance coverage.

3. Other modes of transportation not operated by HCS are not covered

under Henry County Schools Insurance policy.
 4. 15-passenger van In compliance with state law and regulations,
students are not allowed to be transported in a 15 passenger van.

VI. Overnight field trips - housing

A. Arrangements

Prior to the trip, arrange sleeping accommodations for the students and
chaperones.

B. Supervision

Special consideration should be given to the number of chaperones on an

overnight trip as additional chaperones may be needed. Ensure students
have supervision at all times while on a school sponsored field trip. If
chaperones will not sleep in the same rooms as students, discuss how
students will be supervised in their rooms, such as a room check every 30
minutes until the students are asleep.

C. Inspection

If possible, inspect the proposed housing before deciding to use the

facility. In lieu of inspection, obtain recommendations from an approved
travel agency or another school that has used the facility.

D. Providing information to parents/guardians

Communicate housing information, including the name(s), address(es),

telephone number(s), and cost(s) of the proposed housing unit(s) to both
parents/guardians and students. Be sure to specify the housing and
sleeping arrangements in form FT-1 Field Trip Description with Itinerary
and/or form FT-4 Parent/Guardian Field Trip Permission/Emergency
Information/Informed Consent Form.

VII. Parental information and consent

A. Inform parents/guardians

1. Inform parents in writing about planned field trip activities.

Provide a way that parents can ask questions about the trip.

2. For more involved field trips such as out of country or overnight stays,
provide a more formal opportunity for questions, such as an
informational meeting for parents/guardians. Discuss applicable
information regarding the proposed trip, including the following:
 Purpose of the trip and relation to the curriculum or activity program
Budget and fundraising
Proposed detailed daily student itinerary
Arrangements for chaperones
Proposed travel arrangements
Proposed housing arrangements
Proposed eating arrangements
Rules of conduct for students
Reminder that district policies apply, including the prohibition on
drug, alcohol use, and technology use
Parent information and permission requirements
Fees and spending money
Emergency procedures
Potential personal safety risks
Information related to foreign travel, including immunizations
required, passports, laws related to drugs (including prescription
drugs), and appropriate conduct in a foreign country
Keep records of dates of meetings, number in attendance, and
handouts/information given

3. Students attending field trips are expected to abide by the policy of

using electronic devices as defined in Henry County Board policy- IFBGA
.
B. District policies apply

Ensure parents, students and chaperones understand that district policies

and procedures pertaining to student conduct, discipline, and rights apply
to students while on field trips, and that parents will be responsible for
getting the student back home if the student breaks the rules. Rules on
field trips are the same as required of students within the school confines.
Students violating school conduct rules on a field trip are subject to the
same disciplinary action as would apply if they were on school property.

1. Field Trip Behavior and Expectations Student Agreement

C. Related documents

Ensure necessary documents are received by the parent/guardian,

returned to the school, and permission/emergency forms are reviewed by
the school before the trip. Information sent to parents/guardians should
include at least the following:

1. A letter from the school about the field trip

2. Field trip details and itinerary, listing means of transportation and
housing arrangements (if applicable)
3. Things for a student to bring and not bring on the trip, including type of
clothing needed
 4. Field trip permission form FT-4 Parent/Guardian Field Trip
Permission/Emergency Information Informed Consent Form
5. Health information/emergency contacts/permission for emergency
treatment form

VIII. Student preparation and chaperone training

A. Pre-trip training for both students and chaperones

Have the field trip sponsor(s) provide a pre-trip orientation for the students
and chaperones that might include the following topics:

Behavior expectations, including the fact that school behavior and

discipline rules apply on field trips (Behavior Expectations Agreement)
Activities the students will be participating in
Acceptable areas for the student to enter at the facility
Special hazards that have been identified
An itinerary of the trip
A general map of the area
The importance of washing hands after activities (especially if handling
toxic substances or petting animals)
The importance of staying with the group
What to do if separated from the group
Procedures for walking in high traffic areas
Use of the buddy system
Other related information

B. Clothing and equipment

Provide special clothing or equipment if needed. If the district does not

provide it, notify the parent/guardian of the student in advance that they
will be responsible for providing the required clothing or equipment
needed for the trip. Check each participant for proper clothing and
equipment on the day of the trip to ensure it is provided.

C. Valuables and money

Arrange for security of people and possessions (if needed) or encourage

students not to bring valuables.

D. Student Behavior Agreement FT-2 Field Trip Behavior and Expectations

Student Agreement

E. Chaperone responsibilities and training

1. Proper supervision
The main purpose of supervision is to help protect students from
injury or diminish the risk of student injury. Adults do not
automatically have the skills necessary to appropriately supervise
students. Teach chaperones applicable school district policies and
procedures and their duties and responsibilities. Proper
supervision has four basic components:

a. Presence and attentiveness

Being with students at all times, and keeping students

easily in sight. (If one of the chaperones cannot see the
students, the students are not being properly supervised)
Not becoming distracted from duties
Being physically able to participate in the activity as
needed
May not use or possess alcohol or other drugs
May not use tobacco in the presence of, or within the
sight of, students
May not administer any medications, prescription or non-
prescription to students

b. Student behavior monitoring and intervention

Being knowledgeable of and consistently enforcing

school rules and policies
Restricting students from leaving the group, from
roughhousing, horseplay or other inappropriate behavior
Taking appropriate action when rules are not followed or
a student is in danger
Never be in a position in which you are alone with a
student
You are required to report any illness or injury of students
to the administrator on duty

Overnight trips:

Chaperones must assume a 24-hour day responsibility

for students from the time that leave until the time they
return
At hotels, chaperones are assigned a specific block of
rooms and floor area to supervise. Gender of the group
members shall be considered when assigning
chaperones and floor assignments
Students are not allowed to have visitors nor use room
service; students must be in their assigned rooms from
curfew (10PM) until they wake-up
 Chaperones may not retire until all students are in their
rooms, all visiting between rooms has stopped, and the
chaperones are sure the students are secure

c. Hazard surveillance and intervention

Being risk-conscious (prioritizing attention into the areas

where accidents are most likely to occur).
Checking the areas visited, and appropriately addressing
hazards.

d. Provide general guidelines and behavior expectations for

chaperones FT-7 Guidelines for Volunteer Field Trip
Chaperones

Familiarize chaperones with field trip specific emergency

procedures, how to get assistance, and whom to contact
in the event of an emergency
Review any medical concerns with the staff and
chaperones so they are informed of medical issues
before an emergency occurs

F. Emergency communication

1. Provide a method for communication in the event of an emergency

(such as a cell phone), and have an alternate method if the primary
means doesnt work.

2. Provide phone numbers for field trip staff to use to contact a school
administrator on a 24-hour basis in an emergency. Contact a school
administrator promptly in the event of an unusual incident and any
student injury. Allow the school administrator to contact
parents/guardians in serious situations.

G. Access to student health information

1. Obtain student health information (medical conditions, medications,

allergies, etc.) related to potential needs on the field trip. Medical
emergency cards/information/permission for treatment for each student
must accompany the group with a copy kept at the school

H. Distribution of medications

At least one staff member on the trip must be trained to distribute

prescribed medications according to school district procedures and how to
 properly secure medications on the trip. Over-the-counter medications
(Ibuprofen, Kaopectate, Tylenol, Benadryl, Tums, etc.) also require a
district medication form signed by both parent and physician and the
medication must be properly labeled by the parent.

In the event a student requires medical attention, the principal or

designated staff member or qualified person will attend to the medical
situation.

IX. International field trips

These guidelines are in addition to the districts usual field trip procedures; many
of the previously mentioned procedures also apply to extended and foreign field
trips.

A. School board approval

Obtain approval from the school board before talking to students and
parents about the proposed trip. The school board must formally approve
all proposed plans for student travel out of the country. Discuss the
proposed plan with the parents/guardians of the students participating,
either in writing or verbally through group meetings. Keep records of the
dates of these meetings, the number of parents in attendance, and any
handouts/information. Provide parents/guardians and students with a
planned itinerary for the trip, including at least the following information:
departure time, place, major events/activities, travel arrangements,
planned stops, time for return, and place for return.

B. Use of outside sponsoring groups

District sponsored out-of-country field trips can be handled with or without

outside organizations providing travel, housing and curriculum plans and
insurance protection.

If the district decides to use an outside company to sponsor the foreign

field trip, screen the tour company for the following:

1. Reputable company with a good safety record

a. Ask the tour company about their safety record
b. Call other school references that have used the tour
company

2. Has adequate liability insurance

a. At least $1 million liability insurance (minimum coverage)
from reputable insurance company
b. International coverage (at least countries visited)
c. No impairment of aggregate limit (no recent large losses)
 3. Can offer protection for the district
a. Names district as additional insured on liability policy
b. Indemnification (hold harmless) provision in contract protects
district

4. Tour company screens vendors (subcontracted tours, hotels, land

transportation, agencies) they use:
a. F current evidence of liability insurance, at least ($1 million
limit)
b. For good safety record (loss history)
c. For good performance

5. Has written emergency procedures in place for all aspects of the

tour

In both informational meetings with students and parents and in written

materials, provide details of the trip, including locations to be visited, major
activities including tours, travel arrangements, housing/sleeping
arrangements, eating arrangements, suggested clothing and equipment,
and insurance protection. Clearly outline the activities that the district is
controlling and those provided by the tour company.

When the district makes the choice to include an outside sponsoring

organization (i.e., Foreign Exchange Programs), many of the risks and
liabilities are transferred to that organization. As the sponsoring
organization has experience in the preparation, planning and participating
in out-of-country activities, it is versed in the potential pitfalls that can
result in potential injuries, accidents, and travel delays and discomforts. It
should have secured protection from such risks by purchasing insurance
to provide protection for the activity and students. Student housing should
be limited to well-established and reputable hotels/motels. Residing with
host families is not permissible.
When this group is coeducational there shall be at least one chaperone of
each sex. On all trips out of the United States, students shall be
accompanied by chaperones in accordance with the following formula:

10 students of fewer - 2 chaperones

11 to 15 students - 3 chaperones
16 to 20 students - 4 chaperones

One (1) additional chaperone for every additional ten (10) students or
major portion hereof.

C. Information about foreign countries

Provide information about traveling in a foreign country. Discuss potential

safety risks of the particular country being visited with the students,
 parents/guardians and chaperones prior to departure. Ensure that
students and chaperones have the proper immunizations, identification
(passports, visas, etc.), and knowledge of laws specific to the country
regarding drugs and prescription medication.

Review information from the U.S. Department of State International Travel

website at: http://www.state.gov/travel/
for tips on traveling abroad, requirements for U.S. citizens, and for travel
warnings. Consult with the local Consulate office of the foreign country for
specific requirements of visitors to that country.

Advise non-US citizens to determine their immigration status before

entering a foreign country and to take appropriate credentials with them.
Advise all other students to take appropriate identification.

D. Land transportation

Professional drivers should be used to transport students and staff

members. No staff members, chaperones, students, or adult
accompanying the students are permitted to rent vehicles to transport
students or staff members.

E. Air transportation

Make travel arrangements in accordance with established district

procedures. Purchase trip cancellation insurance coverage if the trip is
not planned by an outside organization. If the trip is planned with the use
of an organization, confirm it provides coverage for trip cancellation.

F. Housing

Housing of students in private homes will be approved ONLY if organized

and sponsored by a host organization. Otherwise, the cost of housing
must be obtained.

Determine room arrangements for students and chaperones. Seek input

from teachers and administrators before finalizing room assignments. It is
imperative that you follow the chaperone guidelines as found on page 14
section 2.

Housing information, including name, address and telephone number(s) of

the proposed housing unit(s) must be communicated to both parents and
students.

It is advisable that pre-inspection of the proposed housing be made, prior

to deciding to use the facility. In lieu of pre-inspection, recommendation
from an approved travel agency, the Automobile Club or other school that
has used the facilities is advised.
G. Insurance outside of the U.S.

1. For students

Student accident insurance companies can provide coverage for

medical insurance claims that happen outside the United States. This
is secondary coverage, but is advisable.

2. For staff

Workers compensation covers employees injured in the course of

employment. However, some medical providers may need to be paid
for services at time of rendering.

3. For the district

Contact the districts Risk Management Department to inquire about

liability coverage outside of the United States; coverage may extend
for claims presented in courts in Puerto Rico and Canada. Purchase
International Travel Liability Insurance to insure protection if a third
party is harmed or alleged to be harmed and suit is brought in a foreign
country.

4. Consider other insurance

a. Baggage and property insurance
b. Tour Cancellation and Interruption Insurance

H. Informational meetings for students and parents/guardians

Pertinent information regarding the proposed trip must be discussed with

parents that should include the information as follows:
A detailed itinerary
Travel and housing arrangements
Suggested clothing and equipment
Emergency procedures
Budget and fund raising activities
Rules of conduct
Arrangements for chaperones
Advisor/chaperone responsibilities
Potential safety risks
Permission requirements
Insurance protection
Medication procedures

Provide information related to international field trips such as:

Required immunizations
 Passport procurement
Required personal identification
Laws specific to that country regarding drugs and prescription
medications
Travel Warnings issued to describe long-term, protracted
conditions that make a country dangerous or unstable
Advise aliens, including exchange students, to determine their
immigration status before entering a foreign country and to take
appropriate credentials with them.

Keep records of dates of meetings, number in attendance, and

handouts/information given.

For more information about these guidelines, please call the Administrative Services
Department (770) 957-6601

A special thank you to Educational Services District 112 for their contribution to this
document. http://web3.esd112.org/.
FORMS

The School Field Trip Procedures that precede this section of forms provide detailed guidance for many
aspects of planning and executing field trips. They serve as both a reference for field trip sponsors and a
training tool for staff new to conducting school field trips.

This section contains the related forms that will be used by field trip sponsors. These forms briefly
summarize many aspects of the procedures that follow. They can be photocopied and used as is, or
electronic copies can be obtained from your location principal/administrator.

Following is a list of, and brief descriptions of, the forms that are part of these procedures:

FT-1 Field Trip Description and Itinerary Form

This form helps sponsors fully describe the field trip. Included is a Sample Field Trip Description with
Itinerary so the sponsor has an example of a fully completed form

FT-2 Field Trip Behavior and Expectations Student Agreement

FT-3 Non-Athletic Co-Extra-Curricular Permission Slip Form A

FT-4 Parent/Guardian Field Trip Permission/Emergency Information/Informed Consent Form

This form combines the basic field trip information, medical/emergency information, and informed consent,
so there is only one two-page form that parents/guardians need sign for to give permission for their children
to participate in the field trip

FT-5 This Form Has Been Omitted

FT-6 Volunteer Background Check Process

This three-page document fully describes the background check policy and procedures for
volunteers/chaperones adopted by Henry County Schools

FT-7 Chaperone-Volunteer Guidelines

These two pages provide some general guidelines for chaperones, and a place for the chaperone to provide
emergency contact information

FT-8 Notification to School System Volunteer Obligation as Mandated Reporter

FT-9 Volunteer Driver Checklist

This form facilitates volunteer driver screening and vehicle inspection for volunteers who drive their own
vehicles on field trips

FT-10 Self Transportation Release Form

FT-11 Liability Notice for Employee or Parent Volunteer Transporting Students Form B

FT-12 Pre-Approved Field Trip Request Form

FT-13 Non Pre-Approved Field Trip Request Form

FT-14 Athletic Non Pre-Approved Field Trip

Appendices
Forms
 FIELD TRIP DESCRIPTION AND ITINERARY FORM

The following list assists the sponsoring staff member through the field trip process.
Please see procedures for specific information regarding each item.

DATE STEP 1: INITIAL PLANNING ( 8 WEEKS BEFORE TRIP)

DONE (See School Sponsored Field Trip Preliminary Approval Form)
Determine and document the educational benefit of the field trip (curriculum-
related study, interscholastic athletics, and co-curricular activities)
Develop a description of all activities; include transportation, housing, and
eating plans; list unusual aspects of the trip; include all related brochures
Estimate the planned number and ages of participating students and
chaperones needed
Determine proposed costs and funding
Develop a preliminary itinerary of activities
Identify if the field trip has special hazards, including on/in/near water, in
remote locations/hiking, involving animals, and/or outdoor education; avoid
high-risk activities
Review field trip plan with principal
Secure principals preliminary approval to conduct the field trip, and to
conduct fundraising if applicable (seek school board approval for fundraising
if needed)
Submit to Superintendent or school board for approval if needed (for
overnight, out of state or out of country field trips)
Receive preliminary Superintendent or school board approval
Review procedure for fundraising, and develop a plan including fundraising
activities, a plan for assisting the students who are unable to pay their own
expenses, and a method for return funds if not used for the trip

STEP 2: DETAILED PLANNING (2-8 WEEKS BEFORE TRIP)

Contact place(s) being visited to make preliminary arrangements (if needed)
Evaluate the field trip site for potential hazards, special requirements of
location and activity, and accommodations
Review all contracts and insurance requirements; ensure insurance for out of
country field trips (the principal reviews and signs any contracts and all
forms)
Arrange for transportation:
If school bus or van, submit request to transportation
If other, check with your Executive Officer for guidelines and approved providers
Arrange for housing and assess suitability of housing (if overnight stay);
consider same sex sleeping needs
Arrange for food services (if needed)
Develop a detailed itinerary
Identify risks associated with this field trip

FT-1 RETAIN AT SCHOOL OCTOBER 2017

 FIELD TRIP DESCRIPTION AND ITINERARY FORM

Address unusual aspects of trip with risk manager of HCS

Determine adult supervision needed and arrange for chaperones:
ensure adequate number based on the type of activities planned and the age of
the students for developmental appropriateness; ratio approved by school
administrator ensure qualified for special needs (first aid trained, lifeguard, etc.)
ensure criminally screened
ensure they received district chaperone guidelines
Arrange for needed equipment and supplies, including emergency equipment
Meet with school nurse to plan medication needs/dispensing for students;
arrange for distribution of special medications on the field trip (trained staff
and secured medications)
Assemble parent information/permission packet:
letter home to parents
detailed itinerary of activities
permission forms (informed consent, emergency treatment, medical conditions)
list of things students can and cannot bring, appropriate dress
If academic competition is involved, submit to principal for approval:
written criteria and guidelines used to select participants in academic competitions
written communications used to inform parents and students of the academic
competition and of the governing guidelines
Obtain final administrative approval
If a substitute is required, submit request to principal
Arrange an informational meeting for parents (for overnight, out of state, or
out of country field trips)
Arrange for supervision of students who opt out of the field trip

STEP 3: FINAL ARRANGEMENTS (2 WEEKS BEFORE TRIP)

Provide field trip information to parents including:
letter home to parents
detailed itinerary of activities
permission forms (informed consent, emergency treatment, medical conditions)
list of things students can and cannot bring, appropriate dress
Provide orientation for chaperones, and ensure adequate supervision will be
available
Confirm transportation
Confirm housing (if needed)
Confirm food services (if needed)
Confirm arrangements with place(s) to be visited (if needed)
Confirm availability of needed equipment and supplies
Confirm arrangements for special medications

STEP 4: FINAL CHECKS (DAY OF TRIP)

Confirm there is adequate adult supervision for the trip; check the number and
types of chaperones
Check attendance

FT-1 RETAIN AT SCHOOL OCTOBER 2017

 FIELD TRIP DESCRIPTION AND ITINERARY FORM

Ensure adequate transportation

Ensure parental permission is obtained and emergency information is available:
Every student has returned the parent permission/emergency medical form
Provide the school office with a copy of the signed field trip permission
form/emergency medical form for each student (the original of these forms stay
with the field trip sponsor)
A copy of the parent permission/emergency medical form for each student and
staff member are kept with them
Review behavior and safety standards with students and chaperones before
departure, including:
reinforce school rules and expectations
the system of accounting for students and the use of the buddy system
review emergency procedures (for injury, accident, or inappropriate activity)
explain what to do if a student gets separated or lost from group
Check emergency supplies and essential items for the trip
If special equipment or clothing is needed for each student, ensure that it is
provided
Get medication for students from the office and ensure medications are secured
Make sure that staff/chaperones on the field trip have a 24 hour phone number for
administrators, and the school office/administrator has (cell) phone number of staff
on the trip

STEP 5: AFTER TRIP (SUGGESTED)

After the field trip, evaluate field trip procedures and the activities involved to
ensure field trips in the future are effective and safe
Write thank you notes
Write a news article with pictures about the trip for the local newspaper and/or
Henry County Schools website.

FT-1 RETAIN AT SCHOOL OCTOBER 2017

 FIELD TRIP BEHAVIOR AND EXPECTATIONS
STUDENT AGREEMENT

I, (print student name), understand and agree to

follow the rules and expectations listed below while on my overnight field trip to
(print date(s) and location(s) of field trip).

1. I understand that this is a school approved field trip and that Henry County Schools Student Code of Conduct applies
to my conduct during this field trip. I agree to follow the Student Code of Conduct while on the field trip and
understand that I may be disciplined upon my return if I violate the Student Code of Conduct during this trip.

2. I will conduct myself with maturity, courtesy, and respect toward all parties participating in the field trip, including, but
not limited to, my classmates, chaperones and teachers.

3. I realize the chaperones/teachers are responsible for my welfare and the welfare of the group. Accordingly, I will obey
their instructions at all times. I also understand the sponsoring teacher(s) has the final authority and the right to
administer consequences for any students who are in breach of this agreement.

4. I acknowledge this is an educational trip. I realize my participation in all group meetings, meals, tours, excursions, and
other scheduled events is mandatory. I realize that I will only be exempt from participating in scheduled events if I am
ill and I obtain prior permission from a chaperone/teacher to miss an event.

5. Allocation of free time is at the discretion of the chaperone/teacher. I will never go off alone or make any unplanned
trips or excursions while on the field trip. I will carry the name, address, and phone number of the
chaperones/teachers with me at all times. I will keep a chaperone/teacher informed of my whereabouts at all times.

6. I understand I must stay at the accommodations arranged by the school. Exceptions to this rule will be made only by
prior arrangements, with the principal, parent(s)/guardian(s) and sponsoring teachers.

7. I will remain at my assigned lodgings from 10:00 P.M. to sunrise or a time designated by the sponsor. I understand
that boys rooms are off limits to girls and vice versa. I understand I am not to leave my assigned lodgings after
curfew unless I am accompanied by a chaperone/teacher. In case of emergency, I will immediately contact a
chaperone/teacher.

8. I will respect public and personal property. I understand any damages incurred to public property or personal property
as a result of my conduct will be my responsibility. I understand Henry County Schools is not liable for any damage
that may occur to my personal property on the field trip.

9. I will not drink alcohol, smoke, use other tobacco products, or use illegal drugs and/or medication that is not
prescribed to me during this trip. I will not accept or transport any of these items.

10. I understand that if I do not follow the rules and expectations listed above, or if I engage in illegal activity, I may be
required to come home early. I understand my parent(s) will be financially responsible for making arrangements to
send me home.

I, (print student name), have read the rules and

expectations listed above and agree to abide by them. I understand that I may be disciplined and/or sent home early if I
fail to adhere to these rules and expectations.

Student Signature Date

Parent Signature Date

FT-2 RETAIN AT SCHOOL OCTOBER 2017

 NON ATHLETIC CO-EXTRA CURRICULAR
PERMISSION SLIP FORM A

Teacher Name/Grade: Destination:

Departure Date & Time: Return Date & Time:

Donation Amount (no student will be denied access to a field trip for monetary reasons; however, if donations do not cover the cost of the trip, the
outing may be cancelled):

Chaperones Requested: Yes _____ No _____

Lunch: _____ Child will be allowed to buy a school lunch, or bring a lunch from home.

_____ Child will be allowed to buy a school lunch, bring a lunch from home, or purchase lunch at an outside vendor.

Transportation will be provided by in the following manner: ___ HCS bus transportation

___ Other method (please sign below RELEASE*)

To be filled out by parent/guardian Please complete and return by:

Student Name:

___ My child has permission to attend the field trip.

___ My child does not have permission to attend the field trip.

___ My child will buy a school lunch. ___ I would like to be a chaperone.
___ My child will bring a lunch from home. ___ I (parent) will bring my lunch.
___ My child will bring monies for lunch to ___ I (parent) will purchase a school lunch.
purchase from a vendor

___ My child has medication that should be administered during this trip. (School please attached IHP.)

CONSENT

If any emergency medical procedure/treatments are required by the student during the trip, I consent to the trips supervisor taking, arranging for, or consenting to the
procedures or treatment at his or her discretion. I further release and waive any claim which I or any other person, firm, corporation, or entity may have or claim to
have, known or unknown, directly or indirectly, from any losses, damages or injuries arising out of, during, or in connection with the students participation in the
activity, any trip associated with the activity, or the rendering or emergency medical procedures/treatment, if any. I further agree to indemnify and hold harmless
and reimburse the Henry County School District, the Board of Education, its successors and assigns, its members, agents, employees, and
representatives thereof, as well as the trip supervisor from and for any and all claims and losses.

Signature(s) of Parent(s) or Guardian(s) Date

Other Transportation *RELEASE*

*If other transportation is indicated (i.e., no HCS bus transportation), please fill out below:
While the Henry County School District provides transportation through the utilization of the District bus fleet for many extracurricular events, in some cases school
sponsored transportation is not available. In those instances, it is necessary for the parent/guardian to make arrangements for transportation. The Henry County
School District strongly discourages students from riding with other students to and from extracurricular events and to this end, district employees shall not assign
students to ride with other students.

I, _____________________________________, parent or guardian of _________________________________ (student), hereby give my

permission for my student to ride with the parent volunteer/sponsor to/from the designated extracurricular event:

_____________________________________________________ ______________ ______________________

Signature (s) of Parent(s) or Guardian(s) Date Phone Number

FT-3 RETAIN AT SCHOOL OCTOBER 2017

 PARENT/GUARDIAN FIELD TRIP
PERMISSION/EMERGENCY INFORMATION
INFORMED CONSENT FORM

Field trip information

I hereby give my permission for

(Name of student)

who attends
(Name of school)

to participate in a field trip to

(Destination)

on _________________________ from to
(Date) (Time departs) (Time returns)

for the purpose of

Class/Club/Team:
Staff contact: Phone Number:
Transportation for this activity will be provided by:
___ District bus/vehicle
___ Other (specify)

Food will be provided at/by:

I received a detailed itinerary of the trip Yes No

I received a list of things the student should/should not bring Yes No

Medical/emergency information

Student home phone #: Date of birth:

Student's Address:

Family Physician: Phone #:

Does the student have any medical or physical condition, medication information, or allergies which could
interfere with the students safety? ____ Yes ____ No
If yes, please describe:

In the event of an emergency (injury, illness, unforeseen incident), I wish the following person to be
notified in case I cannot be contacted:

Name: Relationship:

Phone #: Alternate phone #:

FT-4 RETAIN AT SCHOOL OCTOBER 2017

 PARENT/GUARDIAN FIELD TRIP
PERMISSION/EMERGENCY INFORMATION
INFORMED CONSENT FORM

Informed consent

As the parent/guardian of the above named student, I have read the field trip itinerary
and I understand that there may be risks of physical injury associated with participation
in these activities.

I authorize emergency medical professionals to examine and in the event of injury or

serious illness, administer emergency care to the above named student. I understand
every effort will be made to contact me to explain the nature of the problem prior to any
involved treatment. In the event it becomes necessary for the school district staff-in-
charge to obtain emergency care for my student, neither he/she nor the school district
assumes financial liability for expenses incurred because of the accident, injury, illness
and/or unforeseen circumstances.

These activities are an extension of the school education program and student conduct
is to be in accordance with the schools published rules and regulations.

Signature of parent/guardian Date

Printed name of parent/guardian

Parent/guardian work phone Home phone # Cell phone #

I pledge that my conduct will, at all times, reflect credit upon myself, my parents, and my
school. I understand that the school rules of conduct apply while on the trip.

Signature of student Date

FT-4 RETAIN AT SCHOOL OCTOBER 2017

 PARENT/GUARDIAN FIELD TRIP
PERMISSION/EMERGENCY INFORMATION
INFORMED CONSENT FORM

Written Authorization for Self-Administration of Medication

by Minor Children at School
* A current prescription and physicians signature must be provided with this documentation.

Student Name:
Date of Birth: Grade:

I, ________________________________, Parent/Legal Guardian of the above-named student hereby request authorization for self-
administration and possession of asthma medication, epinephrine auto injector, or diabetic medication by this student while in school, at a
school sponsored activity, while under supervision of school personnel, and while in before-school or after-school care on school operated
property. The student demonstrates full understanding of the proper use of his/her medication.
I understand that:
the school district and its employees and agents shall incur no liability for: a) any injury to the student caused by his or her self-
administration of medication except for injury caused by willful or wanton misconduct; b) the students use, misuse, overuse, or
neglected or failed use of his or her medication; and c) lost, misplaced, outdated, inaccessible, empty, or faulty medication and
devices
the school may choose to require supervision of medication administration in the event that the student does not demonstrate
appropriate use or proper technique with medication
the school has the authority to enforce rules and consequences for inappropriate behavior demonstrated by the student in
association with the possession and/or self-administration of medication and that the school has the authority to require supervision
of medication use as deemed appropriate for the safety of all students and staff

I take sole responsibility for:

the monitoring of medication, medication use, and refilling of prescriptions for medication as the school will not be responsible for
the supervising, recording, and monitoring of self-administered medication
ensuring the student always carries his/her medication on his/her person
deciding if back-up medication will be kept at the school and providing the school with the back-up medication
informing school staff in writing of any changes in the students treatment or management
informing the school of any exacerbations, hospital visits, and/or new or changed student medical information
informing school staff in writing of any medication side effects that warrant communication to the parent/guardian
coordinating distribution of the students medical management and emergency plan to school staff (school health worker, teachers,
physical educators, coaches, bus driver, before-school and after-school staff)

I understand and agree to the conditions of the school system policy. I permit the school to seek emergency medical treatment for
the student when deemed necessary and appropriate. I accept legal responsibility should the medication be misused or given or
taken by a person other than the above named student. I release the Henry County School System and its employees and agents of
any legal responsibility related to the above named students possession and self-administration of his or her medication.

Parent/Legal Guardian Signature Date

I, ___________________________________, the above-named student have been instructed in the proper use of my prescription
medication and fully understand how and when to use this medication. I will always carry my medication with me and will not allow
another student to use my medication under any circumstance. I understand and agree to the terms of the school policy.

Students Signature Date

The above named student has been instructed and demonstrates understanding of the proper use of his/her medication. It is my
professional opinion that the student be permitted to carry and self-administer his/her medication. I have provided the
parent/guardian with a written emergency/management plan including the name, purpose, dosage, and administration directions of
the medication.

Physicians Signature Date

Georgia Department of Human Resources, Division of Public Health, Childrens Healthcare of Atlanta & Georgia Association of School Nurses 2004 Georgia School Health Resource Manual Chapter 3
Administration of Medications.

FT-4 RETAIN AT SCHOOL OCTOBER 2017

 SCHOOL VOLUNTEER BACKGROUND
DISCLOSURE FORM

THIS PAGE
INTENTIONALLY LEFT
BLANK

FT-5 OCTOBER 2017

 OFF CAMPUS VOLUNTEER
BACKGROUND CHECK PROCESS

(To be reviewed by the sponsor only)

If your field trip includes parent chaperones, a background check may be

required. Please visit MyHenry Human Resource Services
Mentors/Volunteers/Chaperones for information, requirements, and forms
related to parent chaperone approval. For any additional questions
concerning chaperones, contact Human Resource Services.

Off-campus volunteer background checks will be valid for three school years.
Before sending in a new background check request, please check the Volunteer
Roster on MyHenry to ensure that your parent is not already approved either by
your school or another. By avoiding duplicate (or triplicate!) requests, we can
really cut down on the turnaround time with the sheriffs department in processing
our background checks.
Please be sure to utilize the current school years authorization form. Mentor
Guidelines and authorization forms are sent system-wide to Principals, Assistant
Principals, Counselors, and Graduation Coaches at the beginning of each school
year.
Once a parent/guardian has approval, he/she may volunteer or chaperone in any
capacity deemed appropriate by the principal for that one-year period. Please do
not alter the form in any way. Colored paper is fine, but please do not add logos
or any other additional information that may cause the form to become two pages
or that may compromise the information already there.
Please ensure that the forms are complete. However, keep in mind that the
sheriffs department cannot run a background check on someone who does not
have a valid Social Security Number or someone who does not have a valid
state-issued ID. Both of these areas MUST be complete on the authorization
form or they will be returned.
The Henry County Sheriffs Department will NOT perform a background check on
a minor child. Approvals for minors wishing to volunteer will be at the discretion
of the principal. We do not perform background checks on active HCS students.
The Approved Volunteer Roster will be updated on MyHenry, noting the most
recent approvals, and the date added.
Each school has a contact person responsible for the collection of parent
background check forms, and to serve as a point of contact for Human
Resources concerning parent and mentor volunteers. Your school name and the
name of the contact person must be noted on all background check forms sent in
for processing.
DO NOT send mandated reporting forms to Human Resources. These forms are
to be maintained at the school.
Please do not include these forms as part of your student packets. We
cannot and do not want to require parents to submit to a background check
unless it is their intent to serve your school in one of these capacities.
Forms should be notarized before being sent in for processing.
For questions, please contact Stacey Odom, Human Resource Services at
770-957-5107, or via email at Stacey.Odom@henry.k12.ga.us

FT-6 REVIEW ONLY DO NOT DISTRIBUTE OCTOBER 2017

 OFF CAMPUS VOLUNTEER
BACKGROUND CHECK PROCESS

Following is the Criminal Background Authorization Form to be completed by

your mentors/volunteers. It is imperative that the forms be filled out legibly and
in their entirety. A complete social security number is required by the GBI or the
request will not be processed. Send completed forms to Stacey Odom in
Human Resource Services. Forms can be notarized in Human Resources, if
necessary. Requests are sent to the Henry County Sheriffs Department for
processing, which depending on workload, can take up to 10-14 days. Please
be aware of this time frame when arranging for field trip chaperones and submit
your requests in as soon as possible. Also, be sure to note the school name
and the contact person on the form.

Once the background checks return, you will be contacted by Human Resources
to advise you of all acceptable reports as well as any that may be of concern. At
that point, you will be able to make a final determination regarding your parent
volunteers and their approval to participate in the schools function(s).

Please forward this information to your field trip sponsors. As always, if

you have any questions or concerns, or if there is anything additional that I can
do to assist you, please let me know.

Stacey Odom
Human Resource Services
Henry County Schools
770-957-5107
Stacey.Odom@henry.k12.ga.us

FT-6 REVIEW ONLY DO NOT DISTRIBUTE OCTOBER 2017

 Valid for the following school years: 17/18, 18/19, and 19/20

AUTHORIZATION OF RELEASE OF CRIMINAL

BACKGROUND INFORMATION
- Mentor/Volunteer/Chaperone Consent Form -

School: ______________________ School Contact:__________________________________

To the Sheriffs Department of Henry County:

I hereby authorize any clerk, officer, judge, custodian, or other person to give to the Henry County Schools, 33 North Zack
Hinton Parkway, McDonough, Georgia, 30253, any and all information in their possession regarding my motor vehicle
record, and any criminal history or record pertaining to me, which may be on file with any criminal justice agency, court, or
the GCIC/NCIC, or other information requested upon presentation of this authorization or any reproduced copy thereof.
(O.C.G.A. 35-3-35/35-3-6.) I further give my continuing consent, for officials of Henry County Schools to access such
information throughout the course of my service at intervals, should the Henry County Schools deem further background
checks appropriate.

ALL REQUESTED INFORMATION MUST BE SUBMITTED AND MUST BE LEGIBLE. THE SHERIFFS
DEPARTMENT WILL NOT PROCESS INCOMPLETE REQUESTS, AND INCOMPLETE FORMS WILL BE RETURNED
TO THE SCHOOL.

___________________________________________ ___________-_______-___________
Print Full Name (First, Middle, Last) Social Security Number (Full Number)

_________________________________________________________________________________________
Street Address

_______________________________________ ____________ ___________________

City State Zip Code

____________ ______________ _________________ ____________________________________

Sex Race Date of Birth Drivers License Number/State
(MM/DD/YYYY)

___________________________________________________ ______________________________
Signature Date

Sworn to and subscribed before me this _________ day of __________________________, _________

___________________________________________________
Notary Public

For HR use only:

SUBMIT TO HUMAN RESOURCES

 GUIDELINES FOR VOLUNTEER
FIELD TRIP CHAPERONES

To be reviewed and signed by Volunteer/Chaperone

Thank You for Your Support!

Henry County Schools (HCS) believes that field trips provide a valuable educational experience
for students. Without the help of volunteer chaperones like you, many field trips would not be
possible. We thank you very much for giving your time and support to these important activities.

In order to help ensure that HCS-sponsored field trips result in safe and rewarding experiences
for all participants, we have prepared these guidelines to provide information about volunteering
as a field trip chaperone.

Becoming a Volunteer Field Trip Chaperone

Because student safety is paramount concern, Georgia State law requires HCS to
conduct a criminal record background check of school volunteers with unsupervised
access to children. To accomplish this, all volunteers must complete the GCIC Consent
Form every three years or at the principals discretion.

The HCS also requires that volunteer chaperones be at least 21 years old.

Guidelines for Volunteer Chaperones

Prior to your field trip, the supervising staff member will provide you with information regarding
the activities planned for the trip, expectations for supervising students, and emergency
procedures. In addition, we have developed the following general guidelines to help you
perform your duties as a chaperone. If you have any questions regarding these guidelines,
please contact the supervising staff member or the building principal/program manager.

1. All school rules apply on HCS-sponsored events. Chaperones are expected to comply
with HCS policies, follow the directions given by HCSs supervising staff member, work
cooperatively with other staff and volunteers, and model appropriate behaviors for
students.

2. In order to comply with HCS policy, during HCS sponsored events, chaperones:
may not use, sell, provide, possess, or be under the influence of drugs or alcohol
may not use tobacco in the presence of, or within the sight of, students
may not possess any weapon
may not administer any medications, prescription or nonprescription, to students

3. Students must be supervised at all times while at HCS-sponsored events. As a

chaperone, you will supervise a small group of students, helping them learn and making
sure they behave appropriately. Students must stay with you, their chaperone, at all
times. Go over use of the buddy system with students under your care. Account for all
participants regularly and before changing activities. Be sure you know when and where
to meet the rest of your group at the end of the visit. Chaperones must be readily
available, be mindful of safety concerns, and respond to students needs.

FT-7 RETAIN AT SCHOOL OCTOBER 2017

 GUIDELINES FOR VOLUNTEER
FIELD TRIP CHAPERONES

4. Student behavior is your responsibility. School rules related to student behavior apply.
Go over rules and standards of behavior, safety rules, and any site specific rules with
students. Ensure that students do not get involved in extra activities not pre-approved
by administrators and parents.

5. For the protection of both the student and the chaperone, chaperones should not place
themselves in situations in which they are alone with a student.

6. Family members or friends of a chaperone may not participate in a HCS-sponsored field

trip or event unless prior approval has been obtained from the building principal.
Additional small children can distract you from your duties as a chaperone.

7. Chaperones who transport students in their personal vehicle must complete the HCS
Private Transportation for School Activities form. You are expected to comply with all
HCS and State student transportation rules and regulations. Be aware that your
personal vehicle insurance provides primary coverage in the event of an accident or
injury.

8. Be sure to know what to do in an emergency (medical emergency, natural emergency,

lost child, serious breach of rule, etc.). Know who is first aid trained, where the first aid
kit is, where the cell phone is kept, and who has the copies of parental permission slips
with emergency phone numbers and medical information.

In the event that I have a personal emergency, please contact:

_______________________ ___________________ _________________________

Printed Name Relationship Daytime Phone

I acknowledge that I have received the copy of the Guidelines for Volunteer Field Trip
Chaperones, have read these guidelines, and agree to comply with the guidelines as a school
volunteer.

Printed Name

Volunteer Signature Date

FT-7 RETAIN AT SCHOOL OCTOBER 2017

 NOTIFICATION TO SCHOOL SYSTEM VOLUNTEER
OBLIGATION AS MANDATED REPORTER FOR
SUSPECTED CHILD ABUSE

Pursuant to Code Section 19-7-5 of the Official Code of Georgia Annotated (O.C.G.A), Henry County
Schools must notify individuals who volunteer in the school district of their obligations as mandated
reporters for suspected child abuse.
Child abuse includes:
(A) Physical injury or death inflicted upon a child by a parent or caretaker by non-accidental means;
physical forms of discipline do not count, as long as there is no physical injury to the child;
(B) Neglect or exploitation of a child by a parent or caretaker thereof; or
(C) Sexual abuse or exploitation of a child.

Requirements
Georgia law requires that all volunteers:
1. Report, not investigate, any suspicions of child abuse as defined above to the principal, supervisor,
or designee of the facility within which you are volunteering immediately, but in no case later than
the end of the school day or school event for which you are serving as a volunteer.
2. If the above individuals are not available, then Georgia law requires that you make an oral report
of suspected child abuse immediately to the Department of Family and Children Services, an
appropriate police authority, or a district attorney within 24 hours.
3. If you suspect the child is in immediate danger, you are directed to call 911 immediately.

Guidance

Your verbal report should be made in person or by telephone and followed by a report in writing, if
requested.
Do not contact the parent or guardian.
In causing a report to be made to a child welfare agency, or participating in any judicial proceeding
or any other proceeding that results, you are immune from any civil or criminal liability that might
otherwise be incurred or imposed, provided that you are doing so with good intentions.
A copy of Henry County Schools procedures for reporting suspected child abuse/neglect has been
made available to you on the back of this form. In addition, a video has been made available at
the Henry County School system website that will aid you in understanding the signs and symptoms
of child abuse/neglect. http://schoolwires.henry.k12.ga.us/site/default.aspx?PageID=1
If you have questions, please contact the principal, school designee, or April Brown, Director of
Administrative Services at 770-957-6601.
By your signature below, you acknowledge that you have received a copy of the procedures, you have had
an opportunity to review the form and ask questions, have had an opportunity to review the video if so
desired, and are aware of your obligation to report suspected child abuse/neglect to the appropriate
authorities.

Printed Name

Volunteer Signature Date

FT-8 RETAIN AT SCHOOL OCTOBER 2017

 SCHOOL DISTRICT VOLUNTEER
DRIVER CHECKLIST

TRIP INFORMATION

DATE: SCHOOL:

PURPOSE OF TRIP:

DATE OF TRIP:

TRIP IS TO:

TRIP IS FROM:

MAXIMUM # OF STUDENTS TO BE TRANSPORTED IN VOLUNTEERS VEHICLE:

DRIVER SCREENING/INSURANCE REQUIREMENTS

NAME OF DRIVER:

VEHICLE YEAR/MAKE/MODEL: LIC #:

Please respond to each item with a YES or NO answer:

YES/NO

I am older than 21 years of age.

I have a valid Georgia State Drivers License.

License #: Expiration Date:

I have had no vehicle moving violations or at-fault accidents within the last three years. If
you have had any, please list:

I have automobile liability insurance that is currently in force and meets State
requirements.

Company: Policy #: Exp. Date: _________

I am aware that, in the event of an accident while on a school-related activity, any claims
will be tendered to my personal automobile insurance company, and my insurance is
primary.

_______ I am aware that, in the event of an accident while I am towing or transporting school or
student equipment, any claims will be tendered to my personal automobile insurance
company, and my insurance is primary.

FT-9 RETAIN AT SCHOOL OCTOBER 2017

 SCHOOL DISTRICT VOLUNTEER
DRIVER CHECKLIST

VEHICLE INFORMATION

Please respond to each item with a YES (AGREE) or NO (DISAGREE) answer:

YES/NO

My vehicle has no mechanical or physical defects that would interfere with the safety of
the driver and passengers.

There is a working seat belt for the driver and each passenger, and I enforce the wearing
of seat belts by all.

If my vehicle has dual airbags, I understand that I cannot seat children under 12 years old
or small persons in the front passenger seat.

The above information is true and accurate to the best of my knowledge.

Signature of Volunteer Driver Date

ADMINISTRATIVE REVIEW

If the volunteer will drive for more than one day, the district has obtained the information
to order a motor vehicle abstract (three-year comprehensive record)

If the volunteer will drive for more than one day and will have unsupervised student
contact, the district has obtained the information to order a background information
check.

All students have parental permission to ride with a volunteer driver.

All NO responses have been addressed satisfactorily.

I have reviewed the above information and this driver and vehicle are approved for this trip.

Signature of Administrator/Designee Date

FT-9 RETAIN AT SCHOOL OCTOBER 2017

 FIELD TRIP
SELF TRANSPORTATION RELEASE

FIELD TRIP SELF TRANSPORTATION RELEASE

I, hereby accept my
(Parents name)

son/daughter into my care. This

(Childs name)

releases the Henry County School District from any duty or liability with respect to the transportation of my
son/daughter to and/or from the todays field trip.

Date of Field Trip: _____________________

Initial one or both:

_____ I will transport my student to the field trip.

_____ I will transport my student from the field trip.

__________________________________________ ________________________

Parent/Guardian Signature Date

Note: It is recommended that all students be transported via school/site arrangements. It is the principals discretion
whether or not to allow students to be transported via another means of transportation. If the student is transported
via means other than arranged by the school, the parent releases the School District from any and all liability that
may arise as a result of this alternate means of transportation.

FT-10 RETAIN AT SCHOOL OCTOBER 2017

 LIABILITY NOTICE FOR EMPLOYEE OR PARENT
VOLUNTEER TRANSPORTING STUDENTS FORM B

Employee or Volunteer Name:

Work Location:
HCBOE Employee Only

Activity for which Transportation is necessary (provide specific details for entire trip):

I understand transporting students to any school activity in my personal vehicle places me in a situation of
personal liability. I acknowledge that I will not be covered by a Henry County Board Of Education
insurance policy. My signature below affirms that I fully understand the above risk of personal liability and
still agree to transport students in my personal vehicle.

Employee or Volunteer Signature:

Employee or Volunteer Printed Name:

Date:

School Checklist for Parent Volunteer

(Not applicable for HCBOE Employee)

background check completed and approved by Henry County Board of Education (HCBOE)

volunteer form completed and filed

notification to school principal

FT-11 RETAIN AT SCHOOL OCTOBER 2017

 EDUCATIONAL FIELD TRIP REQUEST
PRE-APPROVED FIELD TRIPS

School: Destination: Grade/Class:

Number of Students Involved: Teacher:
Departure Return
Departure Time: Return Time:
Date*: Date*:
Round Trip Mileage: Number of School Days Missed*:

Program/Content Area: CTAE ELA Fine Arts Foreign Language Math Science
Social Studies Other: (Please Specify)

Transportation Needed: School System Bus (number of buses needed)

School Faculty Member
Charter Bus Name of Company:
No Transportation Needed

Objectives of the Trip (Use additional paper if necessary):

Prior Preparations (Instructional activities or unit of study related to the trip must be completed 3 days before trip):

Follow-up activities (to be completed within 5 days after trip and returned to the Principal):

Instructional Plan for students not going on field trip:

Fee requested from students and parents:

*Fees may not be charged for trips that require time during the school day or result in academic credit. Donations may be requested.

Teachers or other professional personnel to serve as chaperones (minimum of two adults):

Ratios (adults to students): Elementary students 1:15; Secondary students 1:20
1. 4.
2. 5.
3. 6.

Approved By:

Principal: Transportation Request Sent through Edulog:

Date Date

FT-12 RETAIN AT SCHOOL OCTOBER 2017

 EDUCATIONAL FIELD TRIP REQUEST
NON PRE-APPROVED FIELD TRIPS

School: Destination: Grade/Class:

Number of Students Involved: Teacher:
Departure Return
Date*: Date*: Departure Time: Return Time:
Round Trip Mileage: Number of School Days Missed*:

Program/Content Area: CTAE ELA Fine Arts Foreign Language Math Science
Social Studies Other: (Please Specify)

Transportation Needed: School System Bus (number of buses needed)

School Faculty Member
Charter Bus Name of Company:
No Transportation Needed

Objectives of the Trip (Use additional paper if necessary):

Prior Preparations (Instructional activities or unit of study related to the trip must be completed 3 days before trip):

Follow-up activities (to be completed within 5 days after trip and returned to the Principal):

Instructional Plan for students not going on field trip:

Fee requested from students and parents:

*Fees may not be charged for trips that require time during the school day or result in academic credit. Donations may be requested.
Please submit field trip request at least 30 days in advance for Board Approval.
Teachers or other professional personnel to serve as chaperones (minimum of two adults):
Ratios (adults to students): Elementary students 1:15; Secondary students 1:20
1. 4.
2. 5.
3. 6.

Approved By:

Principal: Executive Officer:

C&I Coordinator: Superintendent:

Board of Education Chairperson:

FT-13 SUBMIT TO LEADERSHIP SERVICES OCTOBER 2017

 EDUCATIONAL FIELD TRIP REQUEST
ATHLETIC NON-PRE APPROVED FIELD TRIPS

School: Destination: Grade/Class:

Number of Students Involved: Teacher:
Departure Return
Date*: Date*: Departure Time: Return Time:
Round Trip Mileage: Number of School Days Missed*:

Type of Contest: Overnight In State Overnight Out of State Overnight GHSA State Tournament
________ ________ ________ ________ Other: (Please Specify)

Transportation Needed: School System Bus (number of buses needed)

School Faculty Member
Charter Bus Name of Company:
No Transportation Needed

Reason for the Trip (Use additional paper if necessary):

Prior Preparations for Instruction (Instructional activities or unit of study related to the trip must be completed 3
days before trip):

Follow-up activities for missed instruction (to be completed within 5 days after trip and returned to the Principal):

Fee requested from students and parents:

Tournament entry fee:

Source of funding for hotel:

Please submit field trip request at least 30 days in advance for Board Approval.
Teachers/Coaches or other professional personnel to serve as chaperones (minimum of two adults):
Ratios (adults to students): Elementary students 1:15; Secondary students 1:20
1. 4.
2. 5.
3. 6.

Approved By:

Principal: Executive Officer:

Athletics Coordinator: Superintendent:

Board of Education Chairperson:

FT-14 SUBMIT TO LEADERSHIP SERVICES OCTOBER 2017