field trip proposal form

Field Trip Proposal Form Class: Science Grade Level: 4

Departure Date: October 30, 2015 Departure Time: 9:00 AM

Return Date: October 30, 2015 Return Time: 2:30 PM

# Total Total Students: Stude nts: 26

# Male: 11

# Female: 15

Destination: Bow Habitat Station

 Address: 1440 17a St S! "a#$ar%, AB &2' 4&9

Service Provider Contact ame and P!one: "o $a%itat Station &'()* +,-./5/1

Transportation otes or Special Re0uestsRe0uirements: B(s )(st be acco))o*atin$ to +an*icae* st(*ents wit+ a w+ee#c+air ra)

Destination assessed and ade0uate:  -es o 23 overni4!t  accommodations accommodations accepta%le: 6es 6es o ./A Route assessed and ade0uate:  -es o Trip duration appropriate:  -es o

Sc!ool calendar c!ec7ed 3or con3licts: -es o Parent 2n3o Meetin4 planned:  -es  o A 80ual Access Assured 3or all Students:  -es o

Met!od o3 Transportation:  9al7in4  Sc+oo# owne* b(s  Rental ve!icle  C!arter %us  Pu%lic Transport  Provided % service provider   ;t!er:

8stimated Cost o3 Trip: 416 Pament 2n3o: &i
S(erisors:

Ratios 2n3o:

Teac!er in C!ar4e: os(e a)ire8 List all teac!ers supervisin4:

Min 1:> &oun4er t!an ?* Cell #: &'()* 555.(1+) Cell #s:

!))a ra))er, Mic+ae# 'rier 

&@@@* @@@.@@@@= &@@@* @@@.@@@@

os(e a)ire8, at+erine -(roic+ -(roic+ Teac!er in C!ar4e !as con3irmed volunteers !ave completed olunteer Clearance process:

Min 1:10   'r 6

&@@@* @@@.@@@@= &@@@* @@@.@@@@ Parent o#(nteer na)es an* ce## n()bers )(st be con;ir)e* be;ore *ate o; ;ie#* tri

 -es  o Total um%er o3 Supervisin4 Teac!ers &MF*: M  2, <  2 Parent olunteers &MF* and cell #Bs: Mrs< Martine= &5>-* 555.1111 Mr< and Mrs< u4en= &'()* 555.1+)( Mrs< Smit!= &5>-* 1+)'.55/-

Due to insurance re4ulations= parent volunteers cannot %e transported % sc!ool %usses<

Primar First Aider: os(e a)ire8

Certi3icate $eld:
)< $o !ave !ave t!e students students %een prepare prepared d re: 7noled4e= 7noled4e= s7ill s7ill and attitud attitudes es 3or t!e tripE tripE

tudents have been working on a bridge-building unit plan and learning about the interactions of bridges with the environment. n this trip, students will become more aware about a/uatic habitats and the impact of man-made creations on these areas.

'< 9!at 3ollo up activities ill occurE tudents will use this information to create an artistic rendition of their bridge plan, and in clude their new knowledge of ecosystems. This assignment will be a summative assessment to check their understanding of the unit plan so far.

.otes ;or arent #etter: 0nform parents about the activities that students will participate in at station, the method of transportation, and the 1&2 fee from each student. Sa;et% '(i*e#ines  6es= 2 !ave revieed and applied t!e revenant sections o3 t!e 8mploee Manual

Sa;et% P#an: "rie3l descri%e t!e assessment and preparation t!at !as occurred re4ardin4 t!e

3olloin4: 1< Site Sitet ter erra rain in:: The activities will all be conducted indoors except for the trail trekking. tudents might slip indoors if the floor is wet in the fish hatchery. utside, the ground could be wet, or a student might get in3ured on the trail.

. 9eat!er: 4ost activities will be conducted indoors, except for the trail trekking. )< 5/uipment6clothing7 0f weather is not appropriate, students will be asked a day before to  provide ade/uate outerwear and 3ackets.

). 9ater3ood: 5ach student will be asked to provide his or her own lunch. 5< $aards $aards &i
!)er$enc% P#an: 1< First Aid= Aid= survival survival and repair 7its &as appropriate* appropriate* are are stoc7ed stoc7ed and accessi%le: accessi%le:  -es  o +< List all people people it! First First Aid trainin trainin4ce 4certi3i rti3icati cation on it!in it!in 4roup: 4roup: os(e a)ire8, !))a ra))er, Mic+ae# 'rier, at+erine -(roic+ )< $o ill emer4enc emer4enc services services &i
'< 9!at steps ill %e 3olloed i3 a participant is ill or !as a non.li3e t!reatenin4 inurE upervisors and volunteers will provide first aid, as necessary, depending on the situation.

Proosa# Attac+)ents "+ec#ist: &c!ec7 all applica%le*     

Pro4ramActivit Plan 2n3o  "roc!ures  Pamp!lets 3rom Provider 2nvoicin4  Pament 2n3ormation to Finance ;33ice Parent Correspondence &i
?ist a## *oc()ents / ite)s &eac+er in "+ar$e wi## carr% on tri: &c!ec7 all t!at appl* Trip plan  permits  passen4er mani3estos Student medications  medical in3ormation 8mer4enc contact in3o Parent consent 3orms ;t!er:

Print ame o3 Teac!er in C!ar4e: os(e a)ire8 Print ame o3 Aut!oried Administrator: Mrs ?ocs)it+ Print ame o3 Additional Approval &as needed* A

Date:

Si4nature:

Date:

Si4nature:

Date:

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At co)#etion o; ;ie#* tri, sen* t+e ;o##owin$ to o;;ice ;or arc+iin$: Finalied trip plan Si4ned parental consent 3orms ames o3 Hno.s!osI  An ot!er ot!er applica%le applica%le paperor7 paperor7 • • • •