SAN DIEGO CITY SCHOOLS

Administrative and Legislative Services

STATEMENT OF ACKNOWLEDGMENT AND CONSENT
TO CONDITIONS OF TRIP

I, __________________________________, am an the ___________________________________
       (name of adult)                        (indicate relationship to student, e.g., parent or other relative)

of ________________________________, a student enrolled at ____________________________
              (name of student)                                                                   (name of school)

a public school operated by the San Diego Unified School District.

I understand that a group identified as _______________________________________________
                                                                                            (describe group)

enrolled at the following schools(s): __________________________________________________

has been offered the opportunity to participate in a field trip to ___________________________,

and that I have been asked to accompany these students on their trip during the period from

_________________________________ to ______________________________.

I understand that my participation in the aforementioned program, including the field trip, is voluntary. I agree to pay all expenses for my participation in the field trip including, but not limited to, the cost of airfare and such insurance as may be required by the San Diego Unified School District.

I am aware of the provisions of Education Code Section 35330, which states in part that "… All persons making the field trip or excursion shall be deemed to have waived all claims against the district or the State of California for injury, accident, illness, or death occurring during, or by reason of, the field trip or excursion…"

I have read and understand the foregoing statement and sign it below voluntarily.

Executed in the City of San Diego, County of San Diego, State of California, on

__________________________________________.
                           (date and year)

__________________________________________
                             (Signature)

__________________________________________
                       (Print or Type Name)