SAN DIEGO CITY SCHOOLS
Administrative and Legislative Services

STATEMENT OF ACKNOWLEDGMENT AND CONSENT TO CONDITIONS OF TRIP

I, ______________________________, am an Employee of the San Diego Unified School District,
               (name of employee)

assigned to ______________________________________________, a public school operated by
                                                 (name of school)

the San Diego Unified School District.

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

enrolled at the following schools(s): __________________________________________________

will participate in a field trip to ______________________________________________________,

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

_________________________________ to ______________________________.

Except as may have been agreed between my supervisor and me, or as may be set forth in documents governing my terms and conditions of employment, I agree to pay all expenses for my participation in the field trip, including but not limited to, the cost of airfare. I further agree to donate as much of my time beyond my normal workday as may be required while on the field trip. I understand that I will suffer no loss of pay by reason of participating in the field trip. I further understand that, except as set forth above, I will receive no additional compensation for any such time or services donated by me, or for any other reason, in connection with the trip.

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…"

My acknowledgment of the foregoing paragraph is subject to the proviso that I retain any and all of my employment rights including, but not limited to, district liability insurance, workers compensation insurance, and district health insurance.

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)