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WHEN DO I NEED TO DO A FIELD (Norco College)

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FOR ALL TRIPS –
WHEN DO I NEED TO DO A FIELD TRIP REQUEST?
Field Trip Request must be submitted to the Division Dean or Director six (6) weeks in advance for all
travel
A copy of each participant’s forms must accompany the instructor/advisor and one copy must be on file in
your department’s office and/or college Dean’s office
Emergency Information Form
Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement
RCCD Student Excursion Contract
The instructor/administrator/director/club advisor planning the trip should make transportation arrangements
for the use of District vehicles or a commercial vehicle. A transportation fee from the students may be
required and will be described in the class registration materials or through other notification.
The instructor/advisor needs permission to go by submitting a Travel Request to their department. If the
travel is out of the country (including Baja California) or out of state and over 500 miles from the college
of record, it must have approval from the Board of Trustees. The travel request, after obtaining appropriate
approvals and obtain written approval on the form from the area Dean/Administrator, College Vice
President of Business, and College President. Will be sent by the College President to the Chancellor’s. An
approved copy of the Travel Request must accompany the Field Trip request packet when submitted to
Student Activities.
If using Private Vehicle – Private Vehicle use Consent Form - The driver of the vehicle must have a valid
California driver’s license and an insurable driving record acceptable to the District’s insurance carrier. In
addition, proof of insurance for the private vehicle, with liability insurance limits of $15,000/$30,000, is
required. Proof of a valid CDL, a DMV printout of the driving record, and insurance must be submitted to
the Dean of Student Services prior to the date of the trip. Driving records may not have any moving
violations for the previous three (3) years. The private vehicle insurance is the primary carrier.
TRANSPORTATION GUIDELINES
ACADEMIC LOCAL FIELD TRIP (within Riverside, Imperial, San Bernardino, Orange, Los Angeles, or
San Diego Counties). Academic students only will travel to the field trip location in the same manner in
which they travel to the regularly assigned class. (Not pertain to club(s)/organization(s))
EXTENDED FIELD TRIP (outside of the six (6) Counties listed). The instructor/administrator/
director/club advisor planning the trip should make transportation arrangements for the use of District
vehicles or a commercial vehicle. A transportation fee from the students may be required and will be
described in the class registration materials or through other notification.
Anyone on a field trip into Baja California must have a passport in order to re-enter the U.S.
For more information, please refer to Board Policy #AP 4300 AVAILABLE HERE
04/19
CLUB/ORGANIZATION FIELD TRIP
ACADEMIC FIELD TRIP
Copies of clubs’ approved field trip request, Emergency Copies of the groups’ approved field trip request,
Information Form, RCCD Student Excursion Contract, Emergency Information Form, and Release and Waive
r
and Release and Waiver of Liability form(s) are to
b
e of Liability form(s) are to be kept on file in the Dean of
kept on file in the Student Activities office. The Instruction’s office. The original signed approval
signed approval form(s) are sent directly to the instructo
r
form(s) are mailed directly to the instructor or adviso
r
or advisor and mus
t
accompany them on the trip. Each and mus
t
accompany them on the trip. The instructo
r
student will be checked to verify payment of curren
t
must submit a list of student names and ID numbers to
semester student services fee. your college student services dean at least 7-10 days
p
rior to the field trip. Each student will be checked to
verify
p
ayment of curren
t
semeste
studen
t
services fee.
Field Trips:
1. Funded through ASRCC?
2. Unit/Program reporting
to Dean of Student
Life?
3. None of the above?
1. Funded through ASRCC
All departments will process
their own paperwork unless
the funding is coming from
ASRCC.
Must be a current club with
all completed paperwork.
Packet must be complete,
with all students enrolled
in classes and have their
fees paid.
Student Activities will
process these forms, check
for all requirements being
met and forward the packet
on to be approved by Lisa
Webb.
A PDF or hard copy of the
approved forms will be sent
to the advisor and a file
retained in the Student
Activities office. The
packet MUST accompany the
advisor on the field trip in
case of emergency.
2. Unit/Program reporting to Dean of
Student Life NOT using ASRCC funds.
Unit/Program clerical support will collect and
verify all student forms for completeness and
required criteria. Including, but not limited
to all documentation required for drivers of
private vehicles if utilized.
Coversheets and packets must have all fields
filled out with Department/Unit Directors’
signature, advisor/instructor accompanying the
students and grant/budget code identified.
Once all forms are collected the packet is
submitted in its entirety to Lisa Webb for
signatures. The packet will then be returned to
the unit/program clerical staff to be filed in
office then scanned and emailed or copied and
delivered to the field trip coordinator. The
packet MUST accompany the field trip
coordinator on the trip in electronic or hard
copy form.
3. None of the above.
Unit/Program clerical support will
collect and verify all student
forms for completeness and required
criteria. Including, but not
limited to all documentation
required for drivers of private
vehicles if utilized.
Coversheets and packets must have
all fields filled out with
Department/Unit Directors’
signature, advisor/instructor
accompanying the students and
grant/budget code identified.
Once all forms are collected the
packet is submitted in its entirety
to the program/unit Dean directly
for signatures. The packet will
then be returned to the
unit/program clerical staff to be
filed in office then scanned and
emailed or copied and delivered to
the field trip coordinator. The
packet MUST accompany the field
trip coordinator on the trip in
electronic or hard copy form.
Rev. 02/19
For more information see Field Trip Guidelines and Board Policy 4300
RIVERSIDE COMMUNITY COLLEGE DISTRICT
FIELD TRIP REQUEST
Date of request:
Approximate number of students:
Date(s) of field trip:
Name of course/club:
Time of departure:
Estimated time of return:
Destination:
Transportation:
District Sponsored Rental Vehicle
Private Vehicle
Other ______________________________________________
Approved Driver(s):
Name __________________________ Student Employee
Name __________________________ Student Employee
Name __________________________ Student Employee
Name __________________________ Student Employee
*For Private Vehicles: “Use Consent Form” and all required documents is required for every field trip*
*District Driver approval form, only required once*
Approved
Rejected
Print Name Signature
Instructor/Advisor Attending the Trip
Date
Approved
Rejected
Director/Dean/Vice President/President
Date
*All students must pay their Student Services fees in order to participate*
**Include a copy of T.R. when submitting this paperwork.**
Rev. 02/19
Clear Form
RCCD Student Excursion Contract
Field trips or excursions are for the purpose of educational, cultural, and social enrichment.
Riverside Community College District, the Board of Trustees, College employees or agents and
their sureties shall not be held responsible under any circumstances whatsoever by the
undersigned, his estate, or heirs for any injury, damage, or loss to the person which the
undersigned incurred while on the off-college function.
State of California Educational Code #72640 states: all persons making a 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.
It is imperative that all participants observe the regulations set forth by our College and
California Education Code.
1. Riverside Community College District and California State Education Code prohibit
the consumption of alcoholic beverages during a college function regardless if you
are 21 years old or not.
2. The use of an illegal substance is a violation of state law and district regulations.
3. Destruction of any property is a violation of state law and district regulations. Any
cost associated with such destruction is the responsibility of those involved.
4. Students are expected to attend all agenda events unless they have a valid excuse that
must be pre-approved by advisor, coach, or instructor.
5. California State Education Code and the policies RCCD prohibit possession or use of
alcoholic beverages or any illegal substances during the conference, regardless of
attendee’s age, at any time during the conference, including after formal activities,
and all hours of the night and morning while under the supervision of the college.
Prescription medications should be registered when turning in applications for any
overnight excursions.
6. Any violation of the RCCD Board Policies and Student Code of Conduct may result
in exclusion from future field trips, excursions, and in severe cases, it may result in
suspension or expulsion from the college.
Your signature on the document indicates that you have read the document, understand its
expectations and liability limitations that you are of legal age to sign the waiver, and do so
voluntarily.
Name of Trip/Destination
Departure Date
Returning Date
Print Name (Student)
Date
Signature
Print Name (Witness)
Date
Signature
Print Name (Dean)
Date
Signature
Rev. 02/19
Riverside Community College District
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY
(“AGREEMENT”)
IN CONSI
DERATION, of being permitted to participate in any way in the ______________________
___________________________________________(Activity) for myself, my minor child/ward, my
personal representatives, assigns, heirs, and next of kin:
1. I ACKNOW
LEDGE, agree, and represent that I understand the nature of the (Activity)
_____________________________________________________and that I am qualified, in good
health, and in proper physical condition to participate in such Activity. I further agree and warrant
that if at any time, I believe conditions to be unsafe I will immediately discontinue further
participation in the activity.
2. I FULLY UNDE
RSTAND that (a) Activity involves risk and dangers of serious bodily injury,
including permanent disability , paralysis, or death (“risk”); (b) these RISKS and dangers may be
caused by my own actions, or inactions, the actions or inactions of others participating in the Activity,
the condition in which the Activity, or the negligences of the “Releasees” named below; (c) there may
be other risks and social and economic losses either not known to me or not readily foreseeable at this
time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages
I may incur as a result of participation in the Activity by me.
3. I HEREBY
RELEASE, DISCHARGE, AND COVENANT not to sue the Riverside Community
College District, its Trustees, officers, employees, agents or volunteers, and of applicable, owners and
lessors of the premises on which the activity takes place from all liability, or in part by the negligence
of the “Releasees.” I further agree, that if, despite this release and waiver of liability, assumption of
risk, and indemnity agreement I, or my minor child/ward, or anyone on my behalf make a claim
against any of the “Releasees.” I will indemnify, save, and hold harmless each of the “Releasees”
from any litigation expenses, arbitration expenses, medical expenses, attorney fees, loss, liability,
damage, or cost which may be incurred as the result of such claim.
I have rea
d this agreement, fully understand its terms, understand that I have given up substantial rights
by signing it and have signed it freely and without any inducement or assurance of any nature and intend
it to be a complete and unconditional release of all liability to the greatest extent allowed by law and
agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall
continue in full force and effect.
I, as parent/legal guardian of the minor child listed below, agree to the same terms and conditions of this
waiver for my child/ward who will be accompanying me to said activity.
___________________________________ _________
______________________
Name of Participant (Print) Name of Child/Ward (Print)
___________________________________ _________
______________________
Signature of Participant Signature of Parent/Legal Guardian
__________________ _________________
Date Date
Rev. 02/19
RCCD Emergency Information
Name:
Student ID #:
Email #
CELL Phone #:
Other Phone #
Date of Birth:
Insurance Policy:
Name:
Policy #:
Group #:
Address:
In Case of an Emergency Contact:
Print Name:
Relationship:
Phone #:
Any Known Allergies:
Any Medical Condition Requiring Special Needs:
Medical Consent
In the event of any medical emergency, I grant to the college or any of its representatives
on the trip the full authority to take any action deemed necessary to protect my health and
safety at my expense, including but not limited to, placing the participant under the care of
a doctor or in a hospital at any place for medical examination and/or treatment, or
returning the participant to their home city at his or her own expense if such return is
deemed necessary after consultation with medical authorities.
Initial one of the following statements:
_____ I am 18 years of age or older and am the participant. My birth date is __________.
_____ I am the parent or legal guardian of participant who is under 18 years of age to
whom the above statements apply and for whose benefit I am executing this agreement.
I have read this consent and I understand it terms. I execute it voluntarily and with full
knowledge of its significance.
Signature of Participant or Participant’s Parent or Legal Guardian
Date
Rev. 02/19
City, State
Zip
RCCD Private Vehicle Use Consent Form
It is the philosophy of the Riverside Community College District that students participating in
extracurricular activities or mandatory field trips travel to and from the event in district owned
vans or district leased vehicles with an advisor accompanying the group. Although not
encouraged, there may be extenuating circumstances that warrant exception to this practice. The
advisor, coach, or instructor, and dean pending completion of this form must approve exceptions.
The form must be filed with the Dean of Student Life at least 3 weeks prior to the event.
I understand that to use my private vehicle for transportation to a Riverside Community College
sponsored event, the following shall apply:
1. The club/organization’s advisor, coach, or instructor must give prior approval.
2. The consent form must be filed with the Dean of Student Life.
3. The private vehicle’s insurance is the primary carrier.
4. The driver must have a valid driver’s license and current vehicle registration (copies must
be attached to this form).
5. The driver must provide a DMV printout of their driving record and cannot have any
moving violations within the last three (3) years.* Obtain information and forms for a
nominal fee at http://www.dmv.ca.gov/online/dr/welcome.htm?lang=en
6. The driver must provide proof of:
a. Auto liability insurance with minimum limits of $15,000/$30,000.
b. Comprehensive/collision coverage.
c. Medical payments coverage of $1,000.
d. Copies of the insurance policy (not the card) and the above item(s) must be
attached to this form.
Non-District Transportation Notice
An RCCD employee may provide route information, travel times, and assist in organization of
caravans to and from the event. It is understood that these are only recommendations and that
such recommendations are not mandatory.
Your signature on this document indicates that you have read the document, understand its
expectations and liability limitations, are of legal age to sign the waiver, and do so voluntarily.
_____________________
Date
_____________________
Date
_____________________
Date
___________________________________________
PRINT NAME Signature of driver
___________________________________________
PRINT NAME Signature ofAdvisor/Coach/Instructor
___________________________________________
Signature of Director/Dean/Vice President/President
Note: Copies must be attached for this form to be valid.
*Not required if cleared by the district to drive.
Rev. 02/19
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WHEN DO I NEED TO DO A FIELD (Norco College)

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