School Safety School Safety Policy #2 FIELD TRIPS & EXCURSIONS The Board recognizes that field trips and excursions are important components of a student s development. Field trips and excursions are educationally sound and an important ingredient to the instructional program of the charter school. Such activities supplement and enrich classroom learning and encourage new interests among students, make them more aware of community resources and help students relate their educational experience to the outside world. Properly planned and executed, field trips and excursions enrich the charter school s educational program and the social development of the charter school s students. Field trips and excursions are to be planned and carried out with safety as a priority and in a manner that minimizes the charter school s legal liability and financial cost. Monitoring Field Trips and Excursions The Director/Administrator of the charter school shall ensure that the effectiveness of field trips and excursions are monitored and continually evaluated to ensure that such activities continue to promote the goals and objectives of the charter school s educational program. Teachers are to have a considerable degree of flexibility and innovation in planning field trips. Field Trip and Excursion Planning and Approval All field trips and excursions must receive prior written approval by the Director/Administrator of the charter school. The Director/Administrator of the charter school shall ensure that the sponsoring teacher has set out in writing the educational objective of the activity and how the proposed field trip or excursion relates to the charter school s educational program, the ratio of adult/students for the activity, and plans showing the best use of the students learning time. Such plans must also provide for adequate restroom facilities, that proper food and water will be available during the activity and the means of transportation to and from the activity. Field trips and excursions, including but not limited to California Interscholastic Federation ( CIF ) trips, that are overnight require the above procedure and Director or designee approval. If the Director or designee of the charter school does not approve the field trip or excursion, the reasons for not approving the activity must be stated in writing. The Director/Administrator of the charter school may exclude from the field trip or excursion any student whose presence on the field trip or excursion would pose a safety or disciplinary risk. The Director/Administrator of the charter school shall not approve activities that he/she considers to be inherently dangerous to students. Charter Schools Development Center, 2007 Page 1 of 12 Materials in this publication were adapted under license and with permission from the Charter Schools Development Center and remain copyright 2007 Charter Schools Development Center, all rights reserved. No part of this publication may be reproduced, stored in a retrieval system, resold, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise except as permitted under Section 107 or 108 of the 1976 United States Copyright Act or without the prior written permission of the Charter Schools Development Center.
Permission Slips No student will be permitted to go on a field trip or excursion without a permission slip signed by the student s parent or guardian. The permission slip shall include a waiver of all claims against the charter school, its employees and the State of California for injury, accident, illness or death occurring during or by reason of the field trip or excursion. In addition, the permission slip shall include an emergency telephone number for the student; any medications the student is required to take, along with the time and dosage required; and any medications the student is allergic to or other medical information necessary to ensure the student s safety. All field trips near water require the Swimming Field Trip Supplement Permission Form. One copy of the permission slip shall be filed with the Director/Administrator of the charter school and one copy shall be given to the teacher to take on the field trip or excursion. Accident and Medical Insurance The charter school does not provide student accident or medical insurance. However, information and applications for student injury and medical insurance are available at the school offices. Applications and payments must be sent directly to the insurance company. Supervision of Field Trips and Excursions The sponsoring teacher must be present to supervise the field trip or excursion. The Director/Administrator of the charter school or his/her designee shall be designated as the emergency contact for the group on the field trip or excursion. A first aid kit shall be in the possession of the sponsoring teacher or accompanying charter school employee at all times during the field trip or excursion. If the field trip or excursion is conducted in areas known to be infested with poisonous snakes, the first aid kit must contain medically accepted snakebite remedies. In addition, the sponsoring teacher or Charter school employee of the school who has completed a first aid course which is certified by the American Red Cross and which emphasizes the treatment of snakebites shall participate in the trip. Charter school employees shall not consume alcohol or use controlled substances (except for medications taken under a physician s orders) while accompanying and supervising students on a field trip or excursion. Any injuries or unusual incidents occurring during the field trip or excursion shall be documented in writing by the sponsoring teacher or other charter school employee accompanying the field trip or excursion. Adult/Student Ratio An appropriate adult/student supervision ratio must be observed at all times during the field trip or excursion. Students are under the jurisdiction of the Board at all times during the field trip or excursion and school rules are to be adhered to at all times. Horseplay, practical jokes, harassment, taunting, rough play, aggressive or violent behavior, profanity, viewing of Charter Schools Development Center, 2005 Page 2 of 12
pornographic material and use of alcohol or controlled substances during the field trip or excursion are strictly prohibited. Parent/Guardian Participation in Field Trips and Excursions Parents/guardians are encouraged to participate in field trips and excursions to assist with supervision of students. Parents/guardians accompanying the charter school group shall receive clear information regarding their responsibilities from the sponsoring teacher. Prior to the field trip or excursion, the Director/Administrator of the charter school or his/her designee may hold a meeting for parents/guardians accompanying the charter school group as supervisors to discuss, among other things, safety and the importance of safety-related rules for the field trip or excursion, how to keep a group together and what to do if an emergency occurs. Parents/guardians will be assigned a specific group of students and shall be responsible for the continuous monitoring of these students at all times. Parents/guardians shall not consume alcohol or use controlled substances (except for medications taken under a physician s orders) while accompanying and supervising students on a field trip or excursion. Transportation Consideration will be given to the safest mode of transportation and the safest routes of travel. If travel is by van, the legal occupancy limit must not be exceeded. Seat belts are to be used at all times while traveling. Parents/Guardians/Volunteers will not drive students. Parents may drive their own child to or from a field trip. If transportation is provided by school personnel then the School Driver Registration Form (Exhibit D) will be submitted to the school principal showing proof of current drivers license and current insurance. Under no circumstances shall students transport other students except siblings with parental permission. Defraying Expenses of Field Trips and Excursions Students may help defray field trip and excursion costs through donations. A student may not be denied the privilege of participating in a field trip or excursion due to lack of funds. Other approved funding may also offset expenses of field trips and excursions. The sponsoring teacher must provide alternative educational activities for those students not participating in the field trip or excursion due to choosing not to attend or whose parents/guardians do not give permission for the student to participate in the field trip or excursion. POLICY FOR USE OF DISTRICT VANS 1. Drivers will be employees of the district and have a minimum of 5 years driving experience. 2. A DMV printout must be submitted prior to approval, along with a valid California Driver License. Any driving infractions will be carefully reviewed. The Superintendent will make the final approval on all drivers. Charter Schools Development Center, 2005 Page 3 of 12
LOCAL PROCESS FOR USE 1. School Driver for District Vans Form is submitted to Student Services Manager. 2. Student Services Manager reviews, and forwards form along with copies of DMV printout and personal insurance, to the District Office. 3. District /Business Office will send final approval. Student Services Manager will submit a calendar indicating drivers/dates. MAINTENANCE: The maintenance director will see that the inspections/maintenance services are made. In the event of an accident, a District Vehicle Report will be submitted. (to be attached) Adopted: March 16, 2005 Amended: March 16, 2011 Amended: March 14, 2012 Amended: February 14, 2013 Amended: August 20, 2014 (Update to Swimming Permission Slip Exhibit C) Charter Schools Development Center, 2005 Page 4 of 12
EXHIBIT A: Field Trip Request Form R O S E L A N D C H A R T E R S C H O O L Roseland Acce lerated Mi ddle School Roseland Collegiat e Prep Roseland University Prep FIELD TRIP REQUEST FORM NOTE: All applications for field trip should be filled out and handed in at least two weeks in advance of the trip. Requested By Destination Method of Transportation: Who will be making the arrangements for transportation Name of Contact person at Field Trip Location Number of Students Grade/Class Date of Trip Departure Time Return to school Phone Number of Adults Area of Study Educational Objective How does the field trip relate to the charter schools educational program? Attach or describe the plans for the field trip which demonstrate the best use of the students learning time. How will the trip be financed? If admission fees are needed, a check in the amount of $ will be needed payable to: *Please note that the field trip must provide adequate restroom facilities and that proper food and water needs to be available during the activity. *A first aid kit shall be in the possession of the sponsoring teacher or accompanying charter school employee at all times during the field trip or excursion. If the field trip or excursion is conducted in areas known to be infested with poisonous snakes, the first aid kit must contain medically accepted snakebite remedies. The sponsoring teacher or charter school employee must also be certified by The American Red Cross in a first aid course emphasizing treatment of snakebites. * Overnight field trips require the above form and Board Approval. *The Director/Administrator of the charter school shall not approve activities that he/she considers to be inherently dangerous to students. *If the field trip requires swimming then a separate field trip permission slip is needed. *A student may not be denied the privilege of participating in a field trip or excursion due to lack of funds. FOR PRINCIPAL/BUSINESS OFFICE Budget Code Approved By: Signature: Charter Schools Development Center, 2005 Page 5 of 12
EXHIBIT B: Permission Slip Form. R O S E L A N D C H A R T E R S C H O O L Roseland Acce lerated Mi ddle School Roseland Collegiat e Prep Roselan d University Prep Return This Sheet By: Teacher Date Description of Trip: School Sponsored Field Trip Parent Permission Form Educational Objective Departure Time Estimated Return Time Mode of Transportation: School bus/contract bus (circle one) Employee driver /private car/ school van Driver Name: Walking Other Parents are to complete this section: Student Name: Parent Name: Telephone: Home Work Cell Other person to call in case of emergency: Name Telephone Health Related Information: Health Insurance (please check one): If you do not have medical insurance please contact the school office on information on how to obtain medical insurance. RAMS: 707-546-7050 RUP: 707-566-9990 Kaiser Medi-Cal Blue Cross Other: Please describe below if your child has any special health needs or limitations, including allergies, asthma, etc.: Please indicate specific instructions for above, including the need for PHYSICIAN AUTHORIZED medicines, special procedures (time, dosage, etc), etc.: Please check the box that applies and sign below. I DO NOT give my child permission to attend the field trip. I give my child permission to attend the field trip. I give permission for my child to attend this excursion. I give my permission for my child to be transported as noted above on this form. I also give my permission for school authorities to authorize medical care should the need arise. I give permission for PHYSICIAN AUTHORIZED medication to be administered to my child. All necessary forms for this medication have been completed and are on file in the school office. I hereby release all liability from Roseland Charter School, Roseland University Prep, Roseland Accelerated Middle School, Roseland Collegiate Prep, Roseland School District, and the State of California and all personnel employed by these agencies for injury, accident, illness or death occurring during or by reason of the field trip or excursion. Signature of Parent or Guardian Date Charter Schools Development Center, 2005 Page 6 of 12
Roseland University Prep Students Only Note to students: You must obtain the initials of all of your teachers in order to be eligible to attend the field trip. Note to teachers: All Classroom teachers must initial below for the student to participate in the field trip or indicate why they are not being allowed to attend. Class Period 1 2 3 4 5 6 7 8 Teacher Signature for Student to attend field trip Reason for not allowing to attend field trip. Charter Schools Development Center, 2005 Page 7 of 12
R O S E L A N D C H A R T E R S C H O O L Roseland Acce lerated Mi ddle School Roseland Collegiat e Prep Roselan d University Prep Regresar esta forma: Maestro Fecha Descripción del Paseo: Forma de Permiso para Paseos Patrocinados por la Escuela Objeto Educativo Hora de Salida Hora Estimada de Regreso Modo de Transportación: Camion Escolar/Camion Contratado Maneja un empleado /Carro privado/camioneta de la escuela Nombre Conductor: Caminar Otro Padres llenar esta sección: Nombre Alumno/a: Nombre Padre: Teléfono: Casa Trabajo Celular Nombre otra persona en caso de emergencia: Nombre Teléfono Información de salud relativa: Seguro Medico (favor marcar una): Si no tienen seguro medico favor de comunicarse con la oficina de la escuela para obtener información en como obtener seguro medico. RAMS: 707-546-7050 RUP: 707-566-9990 Kaiser Medi-Cal Blue Cross Otro: Favor de indicar a continuación si su estudiante tiene cualquier limitación o necesidad medica, incluyendo alergias, asma, etc.: Favor de indicar instrucciones especificas para lo antes mencionado, incluyendo la necesidad de medicinas, procedimientos especiales AUTORIZADAS POR UN MEDICO (horario, dosis, etc.), etc.: Favor marcar lo que corresponde y firmar a continuación. Yo NO LE DOY permiso a mi estudiante para asistir al paseo. Yo le doy permiso a mi estudiante para asistir al paseo. Yo le doy permiso a mi estudiante para que asista a esta excursión. Yo le doy permiso a mi estudiante para que sea transportado como se menciona anteriormente. También autorizo que la autoridad de la escuela autorice cuidado medico si es necesario. Doy permiso para que el MEDICO AUTORIZADO administre medicamenta a mi estudiante. Toda forma necesaria para este medicamento ha sido completada y esta archivada en la oficina de la escuela. Yo libero toda responsabilidad a la Escuela Charter Roseland, La Preparatoria Universitaria Roseland, La Secundaria Acelerada Roseland, La Preparatoria Colegial Roseland, Distrito Escolar Roseland, y al Estado de California y todo el personal empleado por estas agencias por daño, accidente, enfermedad o muerte ocurrido durante o por razón de este paseo o excursión. Firma del padre/tutor Fecha Charter Schools Development Center, 2005 Page 8 of 12
Estudiantes de la Preparatoria Universitaria Roseland Únicamente Nota al estudiante: Debes obtener las iniciales de todos tus maestros para poder ser elegible y asistir al paseo. Nota a los maestros: Todo maestro debe inicial a continuación para que el estudiante pueda participar en el paseo o indicar el porque no puede asistir. Periodo de clase 1 2 3 4 5 6 7 8 Firma del Maestro para que el estudiante pueda asistir al paseo Razón porque el estudiante no puede asistir al paseo. Charter Schools Development Center, 2005 Page 9 of 12
EXHIBIT C: Swimming Permission Slip Form. Roseland School District/Roseland Charter School Swimming/Near Water Field Trip Supplemental Permission Form Formulario de Permiso Adiciónal Para Nadar/Estar Cerca del Agua en un Paseo Escolar Dear Parent, Estimados padres de familia, Date: Fecha: A field trip is being planned that involves swimming, wading or being near water, as part of a planned activity, as follows: Se está planeando un paseo escolar donde se nadará, se caminará por el agua o estará cerca del agua como parte de una actividad de la siguiente manera: Date: Time: Fecha: Hora: Location: Lugar: Type of Facility: Tipo de instalación: Swimming or wading will be part of the field trip. Natación o caminando por la agua será parte del paseo escolar Type of swimming supervision provided: Tipo de supervisión proveída durante la natación: Red Cross Certified Lifeguard on duty: Yes No Servicio de Personal de Salvavida Certificado por el Red Cross: Si No Students will be near water, but will not be swimming. Estudiantes estarán cerca del agua, pero no nadarán. HOW WELL DOES YOUR SON OR DAUGHTER SWIM? Qué tan bien nada su hijo o su hija? Cannot Swim Average Swimmer No sabe nadar Nadador promedio Weak Swimmer Strong Swimmer Sabe nadar un poco Sabe nadar muy bein I give my permission for (student s name) to participate in swim activities or the activities near water listed above. Charter Schools Development Center, 2005 Page 10 of 12
Yo doy mi permiso para que (nombre del estudiante) participe en las actividades de natación o actividades cercas al agua como mencionadas arriba. I DO NOT give my permission for (student s name) to participate in swim activities or the activities near water listed above. Yo NO DOY mi permiso para que (nombre del estudiante) participé en actividades de natación o en las actividades cercas al agua como mencionadas arriba. Signature of Parent/Guardian Date Firma del padre/madre/tutor Fecha Charter Schools Development Center, 2005 Page 11 of 12
EXHIBIT D: School Driver Registration Form Roseland School District/Roseland Charter School 1934 Biwana Dr. Santa Rosa, CA 95407 School Driver Registration Form Driver: (check one) Employee Event: Sports School Sponsored Field Trip Name: Address: Driver's License No.: Date of Birth: Telephone No.: Expiration Date: VEHICLE INFORMATION District Van#1(License plate # ) District Van#2 (License plate # ) **District Van Seating Capacity: 10 with driver OR Name of Owner: Address: Year: Make: License Plate No.: Registration Expiration: Seating Capacity: Insurance Company: Telephone No.: Liability Limits of Policy: INSURANCE INFORMATION Policy No.: Expiration Date: DRIVER STATEMENT I certify that I have not been convicted of reckless driving or driving under the influence of drugs or alcohol within the past five years and that the information given above is true and correct. I understand that if an accident occurs, my insurance coverage shall bear primary responsibility for any losses or claims for damages. I certify that I will ensure that all children will be restrained using the appropriate passenger restraint systems. Name: Date: TRANSPORTATION FOR SCHOOL-RELATED TRIPS DRIVER INSTRUCTIONS When using your vehicle to transport students on field trips or other school activity trips, please: 1. Be sure that you have registered with the district for such purposes and have a valid driver's license and current liability insurance at or above the minimum amount required by law for each occurrence. 2. Check the safety of your vehicle: tires, brakes, lights, horn, suspension, etc. 3. Carry only the number of passengers for which your vehicle was designed. If you have a pickup truck, carry only as many as can safely sit in the passenger compartment. 4. Require each passenger to use an appropriate child passenger restraint system (child car seat or booster seat) or safety belt in accordance with law. 5. In case of emergency, keep all the children together and call 911 and the district office. Review by : Date: Approved Date: Charter Schools Development Center, 2005 Page 12 of 12