Starr Ranch CSF Event Permission Slip and Directions

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 Name ___________________Per__ ___________________Per____ __ Grade____ Room Room ____ Where: Audubon Starr Ranch Sanctuary Address: 100 Bell Canyon Rd, Trabuco Canyon, California Time: 9am-12pm When: 5/18/13 UPON REACHING THE GATE, TELL THE DOVE CAYON ENTRY GATE GUARDS YOU ARE WITH “STARR RANCH WEED WARRIORS” Coordinator: Simi Kaur If Lost Please Call: (714) 227-4178 Directions from FHS to Audubon Starr Ranch Sanctuary: **Please ONLY use these given directions and no other form of directions as you will get lost. (No Google Maps, Map Quest, GPS etc.) 1. 2. 3. 4. 5.

Total Time: 45 minutes Head east on Dodge Ave toward Newport Ave

Total Distance: 25.5 miles

Turn right onto Newport Ave Turn left onto Irvine Blvd Turn right onto Red Hill Ave Turn left onto the Interstate 5 S ramp to San Diego

6. Merge onto I-5 S 7. 8. 9. 10. 11. 12. 13. 14.

Take exit 90 for Alicia Pkwy Turn left onto Alicia Pkwy Turn right onto Santa Margarita Pkwy Turn right on Plano Trabuco Road (at the end of SM Pkwy) Turn left onto Dove Canyon Dr to Dove Canyon Security Gate Stay on Dove Canyon Drive, downhill, uphill to: Turn left onto Grey Rock Turn right on access road –  road  – ( Might or might say Bell Canyon Rd ) ( just  just before before our white mailbox: mailbox: “National “National Audubon Audubon Society Starr Ranch Ranch Sanctuary”) Sanctuary”)

15.

Stay on the main single lane road. Continue past the Sanctuary Office and proceed across a wooden bridge to the parking area by a wooden fence. 16. Approximately 1.25 miles to parking lot from previously seen white mailbox mailbox

DRESS CODE/Other Essentials: *Long Pants, Closed Toed Shoes, hat\sunscreen and as always… REMEMBER YOUR CSF SHIRT!! * You may bring a snack or lunch as there is a picnic area at the Ranch

You must bring this Permission and Information Form with you or your service hours will NOT be counted!!! PERM ISSI ON AND I NFORMATI ON FORM TRIP I NFORMATI ON

School: Foothill High School Group: CSF

Destination: Audubon Starr Ranch Sanctuary Duration: 9am-12pm

X Day

Date of Trip: 5/18/13

 Overnight

Advisor: Molina

Activity/Purpose: Community Service Project Departure: Date: 5/18/13 Time: 9am

Return: Date: 5/18/13

Transportation: Own School Vehicle: Other:

Time: 12pm

STUDENT INF ORM ATI ON

 Name:

Date of Birth:

Street Address: City/Zip:

Phone: Home (

)

Parent Work: (

)

Parent/Guardian Name: Insurance Company:

Policy #:

Allergies/Medications/Medical Condition: If you have any special instructions, kindly attach an explanation and check the appropriate box.

 Instructions Attached   No Instructions

Attached EM ERGEN CY CONTA CT (U se a contact other t han parent/guardian li sted above)

 Name:

Relationship:

Street Address: City/Zip:

Phone: Home (

)

Work: (

)

No student shall be prevented fr om makin g the fi eld tr ip or excur sion because of l ack of suff icient f unds.

STUDENT CONDUCT The Principal/designee has thoroughly explained the purpose of this trip, safety rules, and rules of conduct. In addition to rules and consequences established by the transportation provider, facility, or other organizer of this event, all school and district rules apply, including those related to alcohol and drug use. The consequences for violating those rules will be the same as if the violation were committed at school. TO TH E PARENTS Please read carefully the information about the trip, itinerary, and other information provided above. Complete the contact and emergency information. Be sure to check the appropriate box and attach special medical instructions as necessary. Please note that all school rules, including those related to alcohol and drug use will apply while on this field trip. Your student will be held accountable for behavior as if he or she were at school. LI ABIL I TY RELEASE As provided for in California Education Code Section 35330, the parent/guardian waives all claims against the State of California or the Tustin Unified School District, its officers, employees and agents, for injury, accident, illness or death occurring during or by reason of this trip. M EDICAL AUTHORIZATI ON In the event of any illness or injury, the parent/guardian hereby consents to whatever x-ray, examination, anesthetic, medical, dental, or surgical diagnosis and/or treatment and hospital care from a licensed physician and/or surgeon as deemed necessary for the safety and welfare of the student. It is understood that the resulting expenses will be the responsibility of the parent/guardian and the school or district does not provide medical coverage for participants in this activity. I (we) have been informed about this field trip and agree to the Student Conduct, the Liability Release and Medical Authorization.

 _________ Parent/Guardian Signature

Date

___________________

_________

Student Signature

Date

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