Haywood County Schools

School Volunteer Program

Field Trip/Volunteer Application
Must be submitted L week prior to field trip or activity.
PLEASE PRINT

Date

Teacher

School

Voluntee/s Child's

Volunteer/ Chaperone's Name

Address
Date of

Birth

Volunteer's emergency contact phone # (

Phone #

(-)
Contact's name:

TN Driver's License Number:

For the safety and protection of our students, please answer the

following:

Have you ever been convicted, pled nolo contendere (no contest), had a record sealed or expunged, been placed on probation, enrolled
in a pretrial diversion program or had adjudication withheld in a criminal offense, felony, misdemeanor or otherwise, or are there any .
criminal charges pending against you other than a non-criminal or minor traffic violation? o Yes o No'
lf yes, give detoils below. Note: Failure to record such an offense may result in disquolificotion os o Volunteer. DLll/DWl ore criminol

offenses.

Where Arrested Date(s):

Nature of Charge(s) Disposition(s):

please note the rules for field trips;

o No photos or information about the trips should be posted on social media or sent by any means
o All chaperones must be 21 years ofage.
e Attend chaperone training as requested by your school (may be required)

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Dress appropriately.

No siblings can attend.

Supervise your group at all times; be with a Haywood County School's Employee at all times.
Get to know the students in your group. Make the trip a great experience for everyone in the group.
Follow the planned timeline and itinerary. Be sure your group is in the right place at the right time.

Accompany your students to the restroom area. The entire group must stay together'
Never permit students to leave your group.
Smoking, tobacco products, and alcohol are not permitted by School Board Policy.
Do not use profane or inappropriate language.
Do not buy drinks, snacks, treats or souvenirs for your group unless it has been planned as part of the trip.
Do not ask other chaperones to supervise your group.
Do not use cell phones while on duty except for emergency or event related purposes.
ln an emergency, always contact lead teacher first. ln an EXTREME emergency, call 911. Always remain calm.
When riding a school bus follow all school bus rules and the directions of the school bus driver

By signing below you acknowledge that: on behalf of myself, my heirs, assigns, executors and personal representatives, to hold
harmless and defend Haywood County Schools, including the officers, agents, employees or representatives associated with the fletd
trip/activity from any and all liability claims, loss or damage arising from or in connection with my participation in the field trip'

Voluntee/s

Signature

Date
Date

Sponsorfl'eache/s Signature
incipal's Signature

Date-