Fill - Free fillable Travel Guidelines For Student Organizations and Clubs All (Butte College) PDF form

Travel Guidelines

For

Student Organizations and Clubs

All field trips and excursions must be approved as prescribed by this Administrative Procedure. The Club

Advisor will complete the following tasks prior to the date(s) of travel:

1. Create a complete itinerary, identifying such items as educational objectives, assignments, activities,

dates, time, locations, transportation, etc.

2. Complete a Request for Field Trip or Excursion form at least two (2) weeks prior to the trip, and obtain

approval of the ICC Advisor who has oversight responsibility over campus clubs. The field trip or

excursion itinerary should accompany the request.

If field trip or excursion extends beyond the geographical boundaries of California, complete a Request

for Field Trip or Excursion form at least six (6) weeks prior to the trip in order to obtain Board approval

at least one month before travel is to occur; obtain approval of the ICC Advisor who has oversight

responsibility for campus clubs; and submit the Request for Field Trip or Excursion form to the Vice

President for Student Services for approval. The field trip or excursion itinerary should accompany the

request. The Request for Field Trip or Excursion form, after obtaining required approvals, will be sent

by the Vice President of Student Services then to the President’s Office along with a board item for

placement on the board agenda. Included in the board agenda item will be: (i) justification and

background for the field trip or excursion; (ii) names of all participants including students, instructors,

staff, and chaperones; (iii) complete itinerary for the trip; and (iv) preliminary list of all

plans/arrangements with all costs and sources of funding.

3. Complete a Travel Request and Authorization (TR) for reimbursement of expenses for District

employees participating in a field trip or excursion, and obtain approval of the ICC Advisor and Vice

President of Student Services at least (2) weeks prior to the date of travel or six (6) weeks prior to the

date of travel if the trip or excursion is out of state in order to obtain Board approval at least one

month before travel is to occur.

Please note that the cost of meals cannot exceed the Districts meal allowance (breakfast-$11, lunch-

$12, dinner-$23). Meal allowances can be less depending on club finances.

4. Arrange for transportation, accommodations or overnight trips/excursions, and necessary

tickets/admissions to events/venues associated with the field trip or excursion. If any contracts are

required, they must be reviewed by the Business Contracts Office and processed in accordance with

Board Policy and Administrative Procedure 6340, Contracts.

5. Require all field trip or excursion participants to complete and submit a Field Trip or Excursion

Participant Notice form and a Field Trip or Excursion Waiver of Liability, Assumption of Risk, and

Indemnity Agreement form prior to participation. These forms shall be retained in the Student

Activities Office.

6. Complete a Field Trip or Excursion Participants’ List form listing all participants in the field trip or

excursion including emergency contact information. This form shall be retained in the sponsoring

department office in the event of an accident or emergency. A copy of this form should be made and

accompany the field trip/excursion leader on the trip.

Rev. Nov/14

Butte-Glenn Community College District

Request for Field Trip or Excursion

BGCCD-FTEX REQUEST (Rev. 08/14) RISK MANAGEMENT

INSTRUCTIONS

 Approval must be requested and obtained for faculty/staff to schedule students to participate in a District sponsored

field trip or excursion away from the campus at least two (2) weeks prior to the date of the trip or six (6)

weeks prior to the date of the trip if the trip extends beyond the geographical boundaries of California.

 Complete a separate request for each field trip or excursion and submit to the responsible dean or administrator for

approval. For competition or athletic trips, complete a request prior to or early in the semester for all scheduled trips.

 Attach a complete itinerary, identifying activities, travel dates, times, destinations, locations, and transportation.

 If the field trip or excursion is approved, refer to Administrative Procedure 4300 for additional requirements.

Instructor/Advisor Name:

Department:

Course Title & Number, Club, or Team:

Number of Students:

Attach a roster of proposed participants.

Describe the purpose and objectives of the proposed trip.

The trip is:

Required for the course

Optional

Transportation:

Provided by District

Responsibility of Student

Fees:

Requires a fee $

Does not require a fee

Funding Source:

Student Payment

Auxiliary, Grant, or Categorical Program Funds

Additional Information, if any:

Instructor/Advisor Signature

Date:

Phone

Attach a complete itinerary, identifying activities, travel dates, times, destinations, locations, and transportation.

APPROVAL

Dean/Director Signature

Date

For trips extending beyond the geographical borders of California, the following approvals are required.

Vice President Signature

Date

Superintendent/President Signature

Date

Board of Trustees

Date:

Distribution: Maintain this form for five (5) years after the end of the event in the sponsoring department.

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Name ID: Date

Address

Purpose Location

Departure Date Time Return Date Time

ESTIMATED EXPENSES:

No. of Days Estimated Costs Advance Requested

MEALS: Breakfast X =

Lunch X =

Dinner X =

Incidental X =

LODGING: Payable To:

# Zip

REGISTRATION: (attach brochure)

Payable To:

Zip

TRANSPORTATION: * Private District Air

TOTAL COSTS AND REQUESTED ADVANCE

Claimant Signature Date

Supervisor Approval Date

Dean/Admin Approval Date

Budget Code Business Office Review

REQUEST FOR REIMBURSEMENT

(Complete Upon Return Even if No Additional Expenses are Claimed)

ACTUAL EXPENSES: DATE: TOTALS

Breakfast

Lunch

* Departure Time Dinner

Incidental

MEAL AND INCIDENTAL ALLOWANCE IS ONLY AVAILABLE FOR THOSE TRIPS THAT REQUIRE AN OVERNIGHT STAY.

Lodging

Registration

Airfare

Auto Rental/Taxi

Mileage @ =

Parking

Other: (Itemize)

* Must be completed to receive per diem

TOTAL ACTUAL EXPENSES:

LESS ADVANCE AND AMOUNTS CHARGED TO DISTRICT CREDIT CARDS

BALANCE TO EMPLOYEE/(PAYMENT TO DISTRICT)

Claimant Signature Date

Supervisor Approval Date

Dean/Admin. Approval Date

Business Office Review Date

EXAMPLE TR FORM. CONTACT SANTY GRAY AT GRAYSA@BUTTE.EDU TO OBTAIN A FILLABLE FORM

* By signing below, I certify that I have a valid driver's license and that liability insurance coverage is in force. I understand that if I am driving my personal automobile while on District business and I am involved in an

accident, by law my liability insurance policy is used first. The District liability insurance will only be used after my policy limits have been exceeded. The District does not cover, nor is it responsible for comprehensive and

collision coverage of my vehicle. The mileage reimbursement paid by the District covers all operating expenses on my automobile including, but not limited to, insurance, gas, oil, maintenance, etc. I will notify my supervisor

and make other travel arrangements if no valid driver's license or liability insurance coverage is in force.

12.00$

23.00$

11.00$

5.00$

BUTTE-GLENN COMMUNITY COLLEGE DISTRICT

TRAVEL REQUEST AND AUTHORIZATION

(Confirmation Number)

$11.00

$12.00

$23.00

0.575

$5.00

ALL TRAVEL FORMS MUST BE SIGNED AND RETURNED UPON COMPLETION OF TRAVEL

* Return Time

Butte-Glenn Community College District

Field Trip or Excursion

Participant Notice

BGCCD-FTEX PARTICIPANT NOTICE (Rev. 08/14) Page 1 RISK MANAGEMENT

Department

Class/Club/Team

I freely choose to participate in the

Participant Name

Field Trip or Excursion

that begins on:

and ends on: .

Date

If participating in multiple field trips or excursions for a class/club/team, list the multiple activities including the dates of each (if

necessary, indicate “see attached” and use separate sheet).

Rules and Requirements. I understand that I am required to abide by the policies and procedures established by the

Governing Board of the Butte-Glenn Community College District including but not limited to, the District’s Standards of

Conduct, as well as the rules and requirements of the field trip or excursion as set forth by the District and the policies

and procedures set forth by the organization hosting the event.

Independent Activity and Travel. I understand that District is not responsible for any loss or damage I may suffer

when I am traveling independently or I am otherwise separated or absent from any District activity. In addition, I

understand that any travel that I do independently on my own before or after the District sponsored Program is entirely

at my own expense and risk.

Institutional Arrangements. I understand that District is not an agent of, and has no responsibility for, any third

party which may provide any services including food, lodging, travel, or other goods or services associated with the field

trip or excursion. I understand that District is providing these services only as a convenience to participants and that

accordingly, District accepts no responsibility, in whole or in part, for delays, loss, damage, or injury to persons or

property whatsoever, caused to me or others prior to departure, while traveling or while staying in designed lodging. I

further understand that District is not responsible for matters that are beyond its control. I acknowledge that District

reserves the right to cancel the trip without penalty or to make any modifications to the itinerary and/or academic

program as deemed necessary by District.

Health and Safety. I have been advised to consult with a medical doctor with regard to my personal medical needs. I

state that there are no health-related reasons or problems that preclude or restrict my participation in this field trip or

excursion. I have obtained the required immunizations, if any.

I recognize that District is not obligated to attend to any of my medical or medication needs, and I assume all risk and

responsibility therefore. In case of a medical emergency occurring during my participate in this field trip or excursion, I

authorize in advance the representative of the District to secure whatever treatment is necessary, including the

administration of an anesthetic and surgery. District may (but is not obligated to) take any actions it considers to be

warranted under the circumstances regarding my health and safety. I understand that I am responsible to pay all

expenses relating any medical care that I receive resulting from my participation in this field trip or excursion.

Emergency Contact Information:

Name:

Relationship to you:

Address:

City:

State, Zip Code:

Home Phone:

Work Phone:

Email:

Transportation: I acknowledge and understand that unless specifically advised otherwise, the District is not providing

transportation to or from the field trip or excursion and it is my responsibility to arrange for transportation. During

transportation in any personal or private vehicle, I understand that the driver of the vehicle I am riding in is not driving on

behalf of or as an agent of the District, and the District makes no claims as to the driver’s liability insurance, driving

BGCCD-FTEX PARTICIPANT NOTICE (Rev. 08/14) Page 2 RISK MANAGEMENT

history, or vehicle condition. The District is not responsible for any injury or loss which may result from my transportation.

Although the District may assist in coordinating transportation and may recommend travel times, routes, carpooling or

caravanning, any such recommendations are simply advisory and the District assumes no liability for any injury or loss

which may result from such recommendations.

Signature. My signature below indicates that I have read, understood and freely signed this Notice.

Signature of Participant

Print Name of Participant

Date

IF PARTICIPANT IS UNDER 18 YEARS OF AGE.

Signature of Parent/Guardian of Participant

Print Name of Parent/Guardian

Date

Distribution: Maintain this form for five (5) years after the end of the event in the sponsoring department.

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Butte-Glenn Community College District

Waiver of Liability, Assumption of Risk, and Indemnity Agreement

Field Trip or Excursion

BGCCD-FTEX WAIVER (Rev. 08/14) RISK MANAGEMENT

Department

Class/Club/Team

In consideration of being permitted to participate in any way in

Description of Field Trip or Excursion (including start and end dates):

If participating in multiple field trips or excursions for a class/club/team, list the multiple activities including the dates of each (if

necessary, indicate “see attached” and use separate sheet).

Waiver: I acknowledge that the California Code of Regulations Title 5, section 55220 states 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, for myself, my heirs, personal representative or

assigns, do hereby release, waive, discharge, and covenant not to sue the Butte-Glenn Community College District, its

officers, employees, and agents (collectively “District”) or the State of California from liability from any and all claims

including the negligence of the District, resulting in personal injury, accidents, or illnesses (including death) and property

loss arising from, but not limited to participation in the field trip or excursion.

Acknowledgment and Assumption of Risk: I understand that participation in the field trip and excursion carries with it

certain inherent risks that cannot be eliminated regardless of the care taken to avoid injury. I understand and acknowledge that

some of these potential injuries include, but are not limited to: 1) minor injuries such as scratches, bruises and sprains, 2)

major and catastrophic injuries such as loss of sight, broken bones, heart attacks, concussions, exposure to bloodborne

pathogens, exposure to communicable diseases, paralysis and death.

I have read the previous paragraphs and I understand these and other risks that are inherent in the field trip or

excursion. I hereby assert that my participation is voluntary and that I knowingly assume all risks related to the

field trip or excursion. I understand the District, its, officers, employees and agents shall not be liable for any

injury and or illness suffered by me which is caused by or associated with participation in the field trip or

excursion.

Indemnification and Hold Harmless: I agree to INDEMNIFY AND HOLD the District HARMLESS for any and all claims,

actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my

involvement in the field trip or excursion and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is

intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held

invalid, it is agreed that the balance shall continue in full legal force and effect.

Acknowledgement and Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement,

fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I

acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and

unconditional release of all liability to the greatest extent allowed by law.

Signature of Participant

Print Name of Participant

Date

IF PARTICIPANT IS UNDER 18 YEARS OF AGE.

Signature of Parent/Guardian of Participant

Print Name of Parent/Guardian

Date

Distribution: Maintain this form for five (5) years after the end of the event in the sponsoring department.

Butte-Glenn Community College District

Field Trip or Excursion

Participant List

BGCCD-FTEX PARTICIPANT LIST (Rev. 08/14) RISK MANAGEMENT

INSTRUCTIONS

To be completed by field trip or excursion leader to record all student participants’ emergency contact information before

departing on a College sponsored field trip or excursion.

Department:

Field Trip/Excursion Descriptive Title:

Departure Date & Time:

Return Date & Time:

Faculty/Staff Emergency Contact Person:

Phone:

Email:

Please include all participants. Add a second page if necessary.

Participant’s Name

Emergency Contact’s Name

Contact’s Phone

______________________________________

____________________________

______________________________________

____________________________

______________________________________

____________________________

______________________________________

____________________________

______________________________________

____________________________

______________________________________

____________________________

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10.

______________________________________

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11.

______________________________________

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12.

______________________________________

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13.

______________________________________

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14.

______________________________________

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15.

______________________________________

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16.

______________________________________

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17.

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18.

______________________________________

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19.

______________________________________

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20.

______________________________________

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21.

______________________________________

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22.

______________________________________

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23.

______________________________________

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Distribution: Maintain this form for five (5) years after the end of the event in the sponsoring department.

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Fillable Travel Guidelines For Student Organizations and Clubs All (Butte College)

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