Page 1 of 4 Thomas Downey High School PARENTAL AUTHORIZATION FOR STUDENT TO PARTICIPATE IN SENIOR TRIP 2018-2019 has my permission to attend the Senior Trip which will take place at (Name of student) Disneyland & California Adventures Anaheim, CA (Facilities) (Location/City) Date of Event: Tuesday May 21 st & Wednesday May 22 nd Time of Departure: 2:00am, Tuesday May 21, 2019 Time of Return: Approx. 9:00am Wednesday May 22, 2019. Teacher or Leader: Bill Roe / Jamie Watson Method of Transportation: Charter buses I understand that all students going on this trip will conduct themselves in accordance with Modesto City Schools Student Conduct Code. It is further understood that students will go and return from the event in the transportation provided. I, the undersigned parent/guardian, assume financial responsibility should the above-mentioned student have to return to Modesto prior to the end of the trip. Only eligible seniors are allowed to go on the senior trip; no guests are allowed. I understand that Education Code Section 35330 provides in part, as follows: 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. Students must turn in all required paperwork and pay for all fees by the established deadlines in order to reserve a seat on the bus. The TOTAL COST of the trip is $280.00 if paid prior to all established deadlines. If needed, payment for the Senior Trip may be made in payments. If you are fundraising you do not need to follow the deposit deadline date, as long as you are actively fundraising. On or before December 15, 2018 a deposit balance of $150.00 or 6 boxes of candy sold must be received to reserve/guarantee a seat on the bus. The will be a $10 fee for late deposits. The remaining $130.00 balance is due on or before Friday March 15, 2019. If seats remain available after the payment deadlines, late fees will apply. See attached timelines on page 3 and/or check the daily bulletin on line for updated information. Once the trip reaches capacity, a wait list will be started. REFUND POLICY: Contractual obligations with the travel company do not allow for refunds. This includes ineligibility, illness or family emergencies that may arise even on the day of the trip. If the student is not able to attend after payment has been made, it may be possible for the student to sell their spot to another senior on the waiting list up to 14 days before the date of the trip. Neither refund nor exchange is authorized for passengers who miss the scheduled departure. Students are given the opportunity to raise funds through established senior trip fundraisers. Contact the Student Center (209) 574-1698 for more information. Information will also be announced in the school bulletin. ELIGIBILITY: Students with 2 or more U s, suspensions totaling 5 days in the second semester, or having a debt to the school, are not eligible to go on the Senior Trip. Eligibility will be determined based on third quarter grades, and all requirements are listed in the 2018-2019 MCS Student Code of Conduct. I have read and understand the above information. I give permission for my child to attend and pay non-refundable fees for his/her senior trip on Tuesday May 21, 2019 & Wednesday May 22, 2019 (Parent or Guardian Signature) (Date) Page 2 of the permission/consent form is printed on the reverse
Page 2 of 4 Senior Trip 2018-2019 Student Information Form Last Name: (Please Print) First Name: (Please Print) *Student and Parent/Guardian: Please initial below that you understand that there are NO REFUNDS. (Student Initials) (Parent/Guardian Initials) Disneyland Grad Nite Senior Shirt Size: MEDICATION The only way a student may bring any medications (i.e. prescription or over the counter) is by going through the school nurse. Any questions, contact the nurse s office at: 576-4254 Does this student require medication during this trip? Yes or No (please circle one) If yes, what medication is required? Will the medication be needed in Disneyland Park? (i.e.12 midnight 5:30am) Yes or No (please circle one) School Nurse Signature: THIS SECTION MUST BE FILLED OUT COMPLETELY!!!!! PARENT DELEGATION OF AUTHORITY TO CONSENT TO MEDICAL OR DENTAL TREATMENT FOR MINOR CHILD (CIVIL CODE SECTION 25.8). I hereby authorize any adult into whose care said minor has been entrusted to consent to X-ray examination, anesthetic, medical, surgical, or dental diagnosis, or treatment and hospital care upon the advice of a physician, surgeon, or dental licensed under the Medical Practice Act or Dental Practice Act. Child s Medication Allergies (if any): Special Instructions/Health Problems: Name of Medical Insurance: Group/ID Number: Name of Parent/Guardian: EMERGENCY CONTACT INFORMATION (Must be complete) (Please Print) Parent/Guardian Home Telephone Number: Work: Parent/Guardian Cell or Other Telephone Number: Other Emergency Telephone Numbers: Parent/Guardian Signature: Date:
Page 3 of 4 IMPORTANT SENIOR TRIP DATES Please Post Permission slip must be completed and turned in to make a deposit or to fundraise. All deposits and payments are non-refundable and based on availability. 10/8 12/21 Deposit of $150 and permission slip completely filled out to guarantee seat. 10/8 3/15 Fundraising period See Mr. Roe or Jamie Watson (Student Center) to sign up for fundraising and to receive products to sell. March 15, 2019 All Fundraising money or unsold items due to Student Center. March 15, 2019 Total balance of $280 due. Any payments after March 16, 2018 will accrue a $10 late fee. ***Students failing to pay the entire trip fee by Fri 3/15 at 2:30pm will be replaced by a student on the waiting who has paid in full. Mar 18 th May 10 th May 1 st May 10 th If seats are available, total payment of $285 (includes $10 late fee) will be accepted. There is no guarantee seats will remain. Bus Sign Ups IMPORTANT NOTES No Refunds: Fundraisers: Payments Accepted: Eligibility: Unfortunately, your seat is paid for whether you go or not. See the Student Center for more info. You must have both a trip permission slip and a fundraiser permission slip on file in the Student Center prior fundraising. Participating in fundraising DOES NOT reserve your spot on the bus. Candy will only be checked out before or after school. Candy cannot be sold on campus. Before school, after school and at lunch only Payments will only be accepted until 2:15pm Deadlines are firm no late payments accepted Cash, VISA, Master Card & Debit are accepted. CHECKS AND COINS WILL NOT BE ACCEPTED. All participants must be eligible based on 3 rd quarter grades and citizenship. See conduct code for more info. See reverse for trip itinerary.
Senior Trip Itinerary Page 4 of 4 Tuesday May 21, 2019 01:00 am Meet Thomas Downey High School 02:00 am Depart Thomas Downey High School 09:30 am Arrive Disneyland & California Adventure 9:30am 10:00pm 10:00pm 2:00am Enjoy Disneyland & California Adventure with general public Enjoy Disneyland Grad Nite 2019- Admission includes unlimited use of rides and attractions with special themed entertainment venues. Disneyland dress standards will be strictly enforced. Wednesday May 22, 2019 2:30 am Depart Disneyland 9:00 am Arrive Thomas Downey High School Additional Info: *Please read attached handout for ALL QUESTIONS!!! *Students may bring pillow, blanket, small soft cooler bags for sealed beverages for the bus ride. *Bring Money for Food While at Disneyland *You are responsible to bring money for Souvenirs (if you wish to):
Page 5 of 4 All Seniors Participating in Senior Trip Must fill out this form TDHS ASB CLUB PERMISSION SLIP Consent for Participation in Modesto City Schools Associated Student Body Organization has permission to participate as a member of the Student s Name Senior Class 2019 at Thomas Downey High School for the Student Body Organization 2018-2019 school year. A copy of the organization s constitution is on file and available for inspection in the Student Center. Date Parent/Guardian SENIOR TRIP FUNDRAISER PARTICIPATION CONSENT I give permission for my child to participate in fund raising activities sponsored by the club under the guidelines set forth by the Associated Student Body. I understand I/my child will be financially responsible for items released to them for sale and any funds they are to collect. Date Parent Signature Date Student Signature
TDHS Senior Trip 2018-2019 Fundraising Contract You are being given the opportunity to fundraise to help defray your cost ($280) of the Senior Trip on Tuesday May 21, 2019. Page 6 of 4 By signing this contract, you are agreeing to be responsible for one case of candy at a time, which you have chosen to sell. The profit from each case will go towards your senior trip account. Candy Sales are to be done off campus, not during school hours. Coins will NOT be accepted If for any reason you should decide not to attend this senior trip and/or become ineligible to attend this trip, the monies derived from your selling of candy shall be left in the Senior Trip fund. Money derived from selling candy is non-transferable. The deadline for turning in your candy money for credit towards your senior trip will be March 15, 2019. Any balance owed for your senior trip ticket must then be paid in full by March 15, 2019. Suggestions for selling: Don t leave your candy unattended or in a place that someone may get to it. If you lose a case or a case is stolen, then you are obligated for the full amount. Maybe your parents are willing and able to sell candy for you where they work ask! To have your entire trip paid for you will need to sell a total of 11 boxes. Date CANDY $ Paid / Date Print Name ID # Phone Senior Signature Parent Signature Date Date