EDUCATIONAL FIELD TRIP REQUEST FORM

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APPENDIX A EDUCATIONAL FIELD TRIP REQUEST FORM PART A ONE DAY FIELD TRIP REQUEST School: Date of Proposal: Departure Day Date Time Return Day Date Time Destination Subject/Grade Purpose Curriculum

1 APPENDIX A EDUCATIONAL FIELD TRIP REQUEST FORM PART A ONE DAY FIELD TRIP REQUEST School: Date of Proposal: Departure Day Date Time Return Day Date Time Destination Subject/Grade Purpose Curriculum Expectations Type of Transportation Number of Students Involved Grade(s) Number of Supervisors Parent/Guardian Consent Forms will be on file for each student Transportation If : Bus Volunteer Other (Explain) (Other) Financing (Proposed Budget) Anticipated Income Anticipated Expenditures Collected from Students: $ Transportation: $ Admission Charges: $ Dept./Division Budget: $ Meals: $ Other Sources Cost for Occasional Staffing: $ Other (Specify): $ TOTAL: $ TOTAL: $ Is Supply Teacher Coverage Required? Supervisors Names: (Tentative) If : Specify arrangements Will be informed of all aspects of the Educational Excursion? Is this a Travel Agency or Outside Organization? If, what is the name of the agency/organization? Attach the agency s current registration form from the Ministry of Consumer and Commercial Relations and also certificate of insurance. OPHEA and OSBIE Risk Assessments I have read, understand all elements of the OPHEA and OSBIE guidelines and risk management assessments. Submitted by: Teacher s Signature Approved by Principal: Date:

2 EDUCATIONAL FIELD TRIP ALL TRIPS CHECKLIST FORM Before Educational Field Trip: Has the necessary Principal/Superintendent approval been obtained? Have the students been made aware of the rules for safety and conduct on the trip and has the Superintendent s approval been approved for overnight trips? Has a pre-visit been made to the site (whenever possible)? Has a specific itinerary (including provision for free time, if any) and supervisory schedule been prepared which contains each location s: i) Name, ii) Address, iii) Phone Number, iv) Contact person with whom arrangements were made? Is a phone contact person(s) available in the event of a delay and have all parents received a copy of the itinerary? Are all appropriate regulations and guidelines understood and being followed? Has an appropriate educational program been provided for students remaining behind? Have students and/or their guardians been encouraged to carry the health card and insurance information with them on the trip? Has a list of student names, phone numbers, emergency contact name(s), and other known medical conditions been compiled for use on the excursion? Have arrangements been made for all students and staff to participate in Sunday Eucharist if the educational field trip includes a Sunday? I have read, understand and adhered to all elements of the OPHEA and OSBIE guidelines and risk management assessments. Teacher s Name: Date:

3 APPENDIX B EDUCATIONAL FIELD TRIP REQUEST FORM PART B OVERNIGHT FIELD TRIP REQUEST School: Date of Proposal: Departure Day Date Time Return Day Date Time Destination Subject/Grade Purpose Curriculum Expectations Overnight Field Trip Request Number of Students Involved Grade(s) Number of Supervisors Parent/Guardian Consent Forms will be on file for each student Transportation If : Bus Volunteer Other (Explain) (Other) Financing (Proposed Budget) Anticipated Income Anticipated Expenditures Collected from Students: $ Transportation: $ Admission Charges: $ Dept./Division Budget: $ Meals: $ Accommodation: $ Other Sources: (Fundraiser Donations) Cost for Occasional Staffing: $ TOTAL: $ TOTAL: $ Is Supply Teacher Coverage Required? Supervisors Names: (Tentative) Has this been booked through a Travel Agency or Outside Organization? If : Specify arrangements Will be informed of all aspects of the Educational Excursion? If, what is the name of the agency/organization? Attach the agency s current registration form from the Ministry of Consumer and Commercial Relations and also certificate of insurance. OPHEA and OSBIE Risk Assessments I have read, understand all elements of the OPHEA and OSBIE guidelines and risk management assessments. Submitted by: Teacher s Signature Approved: Principal Date of Principal Approval: Approved: Director of Education Approved: Superintendent of Education Date of Approval:

4 EDUCATIONAL FIELD TRIP OVERNIGHT REQUEST FORM Completion of this page is required for overnight field trips only. Detailed and specific answers are required. Please use additional paper if necessary. What steps will the teacher take to fully address student s supervision needs? What steps has the teacher taken to ensure that instructional time has not been lost due to this field trip? What steps will the teacher take to coordinate fund-raising so that all of your students may participate? What considerations of any special needs have been determined (transportation, extra supervision, administration of medicine, etc.? What post-trip activities will occur to enhance curriculum delivery or to enhance the school s spiritual, cultural, social, or athletic programs?

5 EDUCATIONAL FIELD TRIP ALL TRIPS CHECKLIST FORM Before Educational Field Trip: Has the necessary Principal/Superintendent approval been obtained? Have the students been made aware of the rules for safety and conduct on the trip and has the Superintendent s approval been approved for overnight trips? Has a pre-visit been made to the site (whenever possible)? Has a specific itinerary (including provision for free time, if any) and supervisory schedule been prepared which contains each location s name, address, phone number and contact person? Is a phone contact person(s) available in the event of a delay and have all parents received a copy of the itinerary? Are all appropriate regulations and guidelines understood and being followed? Has an appropriate educational program been provided for students remaining behind? Have students and/or their guardians been encouraged to carry the health card and insurance information with them on the trip? Has a list of student names, phone numbers, emergency contact name(s), and other known medical conditions been compiled for use on the excursion? Have arrangements been made for all students and staff to participate in Sunday Eucharist if the educational field trip includes a Sunday? Have all elements of the OPHEA and OSBIE guidelines and risk management assessments been read and understood? Teacher s Name: Date:

6 APPENDIX C PERMISSION / ACKNOWLEDGEMENT FOR EDUCATIONAL FIELD TRIPS and ATHLETIC / CO-CURRICULAR PARTICIPATION THIS FORM MUST BE READ AND SIGNED BY A PARENT/GUARDIAN OF A PARTICIPATING STUDENT. STUDENTS 18 YEARS OF AGE AND OLDER MAY SIGN ON THEIR OWN BEHALF., of the Huron-Perth Catholic District School Board is arranging: (Name of School/Program) (description of activity, location, dates and mode of transportation) Elements of Risk Educational field trips and programs, such as the event described above, involve certain elements of risk including, but not limited to parasitic and fungal risks. Accidents may occur while participating in these activities. These accidents may cause injury. By choosing to permit your child to participate in the activity, you are assuming the risks of participating in the field trip. The elements of risk can be reduced by carefully following instructions at all times while engaged in the activity. The Huron-Perth Catholic District School Board does not provide any accidental death, disability, dismemberment, dental, or medical expenses insurance on behalf of the students participating in this activity. NOTE TO PARENT(S): 1. If volunteer drivers are used, I give permission for my son/daughter to travel with a volunteer driver. 2. Students are not permitted to drive other students. 3. Appropriate sun protection must be provided for outdoor excursions. 4. Please return this form in its entirety. Please list any medical conditions or procedures (e.g. diabetes, asthma, allergies, etc.) that pertain to your son/daughter. Permission and Acknowledgement I have read the above and give (Name of Student) permission to participate in the to be held on or about My child is provided with appropriate sun protection for this activity. Signature of parent/guardian/adult student: Date:

7 APPLICATION TO PRINCIPAL TO BE A VOLUNTEER DRIVER APPENDIX D This will authorize (Name of teacher or other volunteer driver) 1. To transport students participating in the events listed on the attached school schedule: OR 2. To transport students participating in the following school activity: Vehicle/s Information: 1. Make: Year: Licence #: 2. Make: Year: Licence #: Date School Name Principal s Signature All * Volunteer Drivers are advised that, in order to bring into effect the Board s Excess Insurance coverage, they must: a) Use a licensed automobile which carries valid third-party liability insurance as required under legislation in the Province of Ontario. b) Provide the Board prompt written notice, with all available particulars, of any accident arising out of the use of a licensed automobile during a trip on business of the Board. c) Be aware that the Board s excess liability insurance comes into effect only after the Volunteer Drivers insurance has been exhausted, to a combined total of $20,000,000. d) Have a minimum of $1,000,000 insurance liability. te: * A Volunteer Driver is defined as any person authorized by the Board who has agreed to be a driver for an Educational Excursion while they are driving their own or another licensed automobile (includes trustees, employees, teachers, parents, volunteers and officials of the Board). Employees of the Board are not required to transport students nor should this be an expectation of staff who volunteer for co-instructional activities. Under no circumstances shall students transport other students. 1. Declaration to be signed by Driver: I declare that I am 18 years of age or older and I am fully licensed: I am licensed to drive in Ontario and my vehicle is insured by valid automobile liability insurance as required by Ontario law. /_# (Insurance Company/Policy Number) The vehicle is mechanically fit and that there are seat belts in working condition for all passengers. Where the vehicle is equipped with passenger-side air bags, I will comply with the advice contained in the owner s manual with respect the safety of children seated in the front seat. When transporting children who weight less than 18 kg (40 lbs.) appropriate car/booster seats are provided and properly secured per manufacturer s instructions. I have an up-to-date police vulnerable sector record check on file with the school. Signature Date 2. Declaration to be signed by the owner of the vehicle (if the volunteer driver does not own the vehicle): I declare that: I have authorized to drive my vehicle Vehicle Make/License Number To transport students participating in the school event(s) listed on this form. He/She is 18 years of age or older, properly licensed to carry passengers and is fully insured as a driver under the vehicle liability insurance as required by Ontario Legislation. Insurance Company/Policy Number The vehicle is mechanically fit and that there are seat belts in working condition for all passengers. Where the vehicle is equipped with passenger-side air bags, he/she will comply with the advice contained in the owner s manual with respect to the safety of children seated in the front seat. When transporting children who weigh less than 18 kg (40 lbs.) appropriate car/booster seats are provided and properly secured per manufacturer s instructions. Signature Date

EDUCATIONAL FIELD TRIPS PROCEDURES MANUAL

EDUCATIONAL FIELD TRIPS PROCEDURES MANUAL TABLE OF CONTENTS Section I Approval Process/Educational Field Trip Request 3 Section 2 Principal Approval Process... 4 Section 3 Teacher Request & Follow Up Process.