Voluntary Field Trip/Excursion Notice
I UNDERSTAND THAT PURSUANT TO THE CALIFORNIA CODE OF REGULATIONS,
SUBCHAPTER 5, SECTION 55450, BY PARTICIPATING IN THE VOLUNTARY FIELD
TRIP(S)/EXCURSION(S), I AM DEEMED BY LAW TO HAVE WAIVED ANY CLAIMS AGAINST
WEST VALLEY-MISSION COMMUNITY COLLEGE DISTRICT FOR INJURY, ACCIDENT,
ILLNESS OR DEATH OCCURRING DURING OR BY REASON OF THE FIELD TRIP/EXCURSION.
I FURTHER UNDERSTAND THAT PARTICIPATION IN A FIELD TRIP/EXCURSION IS
VOLUNTARY.
I AGREE TO ADVISE THE DISTRICT IN WRITING OF ANY MEDICAL, PHYSICAL OR HEALTH
CONDITION WHICH MAY BE AFFECTED OR IN ANY WAY JEOPARDIZED BY PARTICIPATING
IN A SPECIFIC FIELD TRIP/EXCURSION.
Name of Event:
Date(s) of Event:
In The Event Of Accident Or Illness Please Notify:
Emergency Contact Name:
Emergency Contact Address:
Emergency Phone: (H)
(W)
I hereby acknowledge and understand that unless specifically advised otherwise, the District is not
providing the transportation and it is my responsibility to arrange for my transportation to and from the
activity. It is further understood that the driver of the vehicle in which I am riding is not driving on behalf
or as an agent of the District, and the District has not verified the driving record of the driver, the liability
insurance on the vehicle, or the condition of the vehicle.
I understand that the District is in no way responsible, nor does the District assume liability, for any injury
or loss which may result from my transportation.
Although the District may assist in coordinating the transportation and/or recommend travel time, routes,
car pooling, or caravanning, I understand that any recommendation(s) or travel assistance provided is not
mandatory.
NAME (PRINT)
SIGNATURE
DATE
