2022-2023 CBA Chaperone Form – Charleston Bilingual Academy

CBA 2022-23 Field Trip Chaperone Form

Chaperone Name(Required)

First Last

Chaperone Phone Number(Required)

Description of Field Trip (Ex: Grade 4 Trip to Fort Sumter)

Enter CBA Student's Name and Relationship (if applicable)

First Last

I have read and agree to abide by the CBA Field Trip Expectations for Students and Chaperones document.(Required)

I agree

As a Parent Volunteer Chaperone, I understand that my role is to ensure the safety and well-being of all students assigned to my supervision. Therefore, I agree to do the following: Support the supervising teacher/sponsor in enforcing established rules, procedures, and expectations for student participation and effort. Commit my undivided attention to the students I am assigned to supervise; therefore, I shall not engage in activities that distract my attention from the students I supervise. For the safety of the students I am chaperoning, I understand that I may not bring other children with me while chaperoning. Model appropriate language and behavior and abide by all Charleston Bilingual Academy policies and regulations which govern the behavior of employees during working hours for the entire duration of the field trip while in the presence of students.(Required)

I agree to transport students in my own vehicle, and this is the vehicle make and model:

I agree to transport students in my own vehicle, and this is my license tag number:

I agree to transport students in my own vehicle, and this is my insurance company and policy number:

I will be transporting students in my own vehicle and will provide proof of insurance to the Charleston Bilingual Academy office BEFORE the day of the field trip. (Please either A) Take a picture of the front and back of your driver's license and email to admissions@charlestonbilingualacademy.org OR B) Bring a copy to the receptionist). I understand that my vehicle insurance shall serve as the primary insurance coverage in the event of an accident during the field trip.

I agree

I will provide a copy of my driver's license to the Charleston Bilingual Academy office BEFORE the day of the field trip so the CBA Office can run a background check. (Please either A) Take a picture of the front and back of your driver's license and email to admissions@charlestonbilingualacademy.org OR B) Bring a copy to the receptionist).

I agree

Signature

Date