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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 Students: 26
# Male: 11
# Female: 15
Method of Transportation:
Walking
School owned bus
Rental vehicle / Charter bus
Public Transport
Provided by service provider
Other:
Supervisors:
Ratios Info:
Min 1:10 (K Gr 6)
Yes / No
Total Number of Supervising Teachers (M/F):
(M) 2, (F) 2
Parent Volunteers (M/F) and cell #s:
Mrs. Martinez, (587) 555-1111
Mr. and Mrs. Nyugen, (403) 555-1230
Mrs. Smith, (587) 1234-5567
Supervision Plan:
1. Identify the roles and responsibilities of supervisors (i.e. large and/or small group supervision,
group management, night checks, activity instruction, other)
Parent volunteers will assist with group management and small group supervision, and
teacher volunteers will assist in activity instruction.
2. When/how will volunteers be briefed regarding their roles, responsibilities and expectations:
Parent volunteers will meet with teachers regarding their duties a week before the field trip.
Area of Study
Educational Value:
1. What are the educational/social/recreational goals of the trip?
To explore and interact in a hands-on environment with Albertas fish, wildlife, water and wetland
ecosystems.
2. What activities will occur during the trip (or include an attached trip plan or itinerary)?
3. How have the students been prepared re: knowledge, skill and attitudes for the trip?
Students have been working on a bridge-building unit plan and learning about the interactions of
bridges with the environment. On this trip, students will become more aware about aquatic habitats
and the impact of man-made creations on these areas.
following:
1. Site/terrain: The activities will all be conducted indoors except for the trail trekking. Students
might slip indoors if the floor is wet in the fish hatchery. Outside, the ground could be wet, or
a student might get injured on the trail.
2. Weather: Most activities will be conducted indoors, except for the trail trekking.
3. Equipment/clothing: If weather is not appropriate, students will be asked a day before to
provide adequate outerwear and jackets.
4. Water/food: Each student will be asked to provide his or her own lunch.
5. Hazards (i.e. driving, weather, animals, insects): The route to the site will be assessed
beforehand and plans will be shared with the bus driver.
6. Contingency Plan(s): Written plans will be printed and available a week before, in the event
of a teachers absence, and a substitute teacher will accompany the class.
Emergency Plan:
1. First Aid, survival and repair kits (as appropriate) are stocked and accessible: Yes / No
2. List all people with First Aid training/certification within group:
Josue Ramirez, Emma Krammer, Michael Grier, Katherine Yurkovich
3. How will emergency services (i.e. police, fire, ambulance, search and rescue) be activated if
need in the area?
Teachers and parent volunteers will have cell phones readily available in the event of
an emergency.
4. What steps will be followed if a participant is ill or has a non-life threatening injury?
Supervisors and volunteers will provide first aid, as necessary, depending on the situation.
Program/Activity Plan
Info / Brochures / Pamphlets from Provider
Invoicing / Payment Information to Finance Office
Parent Correspondence (i.e. equipment list, itinerary, etc.)
Other:_______
List all documents / items Teacher in Charge will carry on trip: (check all that apply)
Trip plan / permits / passenger manifestos
Student medications / medical information
Emergency contact info
Parent consent forms
Other:
Date:
Signature:
Date:
Signature:
Date:
Signature: