HomeMy WebLinkAboutAfter Schoool Pgrm @ Lincoln School - Field Trip Forms Contract No. C27900
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� � CITY OF PALM DESERT
COMMUNITY SERVICES DEPARTMENT
STAFF REPORT
REQUEST: Approval of field trip forms to be used in connection with the City sponsored
After School Program at Lincoln Elementary School
DATE: August 28, 2008
CONTENTS: 1) City of Palm Desert/Family YMCA of the Desert Permission Slip
2) Desert Sands Unified School District Field Trip Authorization
Recommendation:
By Minute Motion, approve the use of forms generated by the City of Palm Desert/Family YMCA of
the Desert and Desert Sands Unified School District to allow students enrolled in the City
sponsored After School Program to participate in field trips associated with its civic engagement
component.
Background:
The City of Palm Desert sponsors and funds an After School Program at Lincoln Elementary
School. Beginning in the 2008/09 academic year, a civic engagement/mentoring component has
been added to the program curriculum. This component will consist of an exchange between
students enrolled in the program and City staff, as well as members of the Palm Desert Youth
Committee. The exchange will provide an opportunity for the students to learn and be mentored by
City staff and a member of the Palm Desert Youth Committee about programs, services,
responsibilities, and the advantages of living and working in Palm Desert. Some of the activities
being proposed involve a field trip to the Palm Desert Civic Center. Since the students will be
leaving the Desert Sands site, it is necessary to obtain parental permission and hold "harmless"
agreements with all participating partners.
Therefore, staff recommends that the City Council approve the use of the attached City of Palm
Desert/Family YMCA of the Desert and Desert Sands Unified School District Field Trip Permission
for s for Lincoln After School Program Participants.
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PATRICIA SCULLY PAUL GIBSON
SENIOR MANA EMENT A ST DIRECTOR OF FINANCE/CITY TREASURER
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f` SHEILA R. ILLI AN R OS L. ORT
ASSISTANT CITY MANA E CITY ANAG
City Council Meeting — August 28, 2008
X. CONSENT CALENDAR
g• REQUEST FOR APPROVAL Of Field Trip Forms to Be Used in Connection
with the City-sponsored After School Program at Lincoln Elementary School
(Contract No. C27900).
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C�� THE DESERT
The Lincoln YMCA, in partnership with the City of Palm Desert, will be implementing a
civic engagement/civic mentoring component to its curriculum for the 2008/2009 school
year. An added feature will be an opportunity for the students to learn more about civics
by visiting Palm Desert City Hall. We are asking permission from the parent/guardian
for your child (ren) to participate in this activity. The children will be walked over to
City Hall at 3:00 p.m. and returning to Abraham Lincoln Elementary at 4:30 p.m. The
field trip will be adequately staffed; however, we more than welcome parent volunteers.
I give permission for my child to attend the field trip to Palm Desert City Hall on
from 3:00-4:30 p.m.
Child's Name Parent's Name
Parent's Signature Date
DESERT SANDS UNIFIED SCHOOL DISTRICT
47950 Dune Palms Road
La Quinta, CA 92253
(760) 777-4200
VOLUNTARY EXCURSION/FIELD TRIP NOTICE AND MEDICAL
AUTHORIZATION- MINOR
Dear Parent/Guardian:
Kindly complete and return two signed copies of this form to
(name) has my permission to participate in the following voluntary activitv:
Destination:
Departure Date&Time: Return Date&Time:
In the event of illness or injury, I do hereby consent to whatever x-ray, examination, anesthetic, medical,
surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment
of the attending physician, surgeon, or dentist and performed by or under the supervision of a member of
the medical staff of the hospital or facility furnishing medical or dental services.
As stated in California Education Code Section 35330, 1 understand that I hold the Desert Sands
Unified School District its officers, agents and employees harmless from any and all liability or
claims,which may arise out of or in connection with my child's participation in this activity.
I fully understand that participants are to abide by all rules and regulations governing conduct during the
trip. Any violation of these rules and regulations may result in that individual being sent home at the
expense of his/her parendguardian.
Parent/Guardian Signature: Date:
Address: Phone:
Student Signature: Date of Birth:
Medical Insurance Carrier Policy No. Address
A special note to Parent/Guardian: (1) All drugs must be registered on this form; (2) All drugs, excepting
those which must be kept on the student's person for emergency use, must be kept and distributed by the
staff; (3) _Check here if there are special problems that the staff should be aware of and no drugs are
required on the trip; (4) If any medication or drugs are to be taken by student, list them here: (Name of
drug and reason) If your son or daughter has a special medical
problem,kindly attach a description of that problem to this sheet.
3 NCR rev 2/08 (10)-24