IJOAA-E

File: IJOAA-E

REQUEST TO THE SCHOOL COMMITTEE FOR OVERNIGHT

AND OUT OF STATE TRIP AUTHORIZATION

THIS REQUEST MUST BE APPROVED BY THE SCHOOL COMMITTEE PRIOR TO PUBLICATION OF THE TRIP AND COLLECTION OF MONEY

School ___________________________________ Trip Location

1. Today's date Event Coordinator/s _________________________

2. Name, location and description of trip/event (Include name of sponsoring organization if other

than a school-sponsored student group)

3. Date(s) of the Trip/Event for which School Committee authorization is being sought _________

4. Explain how this activity supports the mission of the school, the curriculum and/or the goals

of the student organization

________________________________________________________________________________________________

5. Estimated number of students who will participate in the trip

6. List the names and roles of the chaperones (10 to 1 staff/student ratio is recommended. If not meeting this ratio,

please explain:_______________________________________________________________________________

_________________________________________________________________________________________________

7. What safety procedures are in place for supervisions and medical emergencies? ____________________________

_________________________________________________________________________________________________

File: IJOAA-E

Financial Information

8a. Cost per student $ X # of students = $

8b. Cost of Program $ Cost of Transportation $

8c. Cost per Chaperone $ Cost paid by Chaperone $

8d. Chaperone cost included in student fee? Yes No

8e. Identify fund raising used to lower cost per student or subsidize student fees

8f. How much money do you anticipate raising to offset the cost to students?

8g. Identify any other costs of participating in this trip/program, e.g., extras,

optional activities, etc.

8h. Are all meals, including those while in transit, included in the per student

fee? (If no_, identify) Yes No

1. Explain the cancellation and refund policy

_________________________________________________________________________________________

Additional Information _____________________________________________________________________________

Staff Members Signature _______________________________________ Date ______________________

Principal's Approval Signature Date

Superintendent's Approval Signature ______________________________ Date

Attach ten (10) copies of all the literature (letters, flyers, brochures, etc.) that will be sent to

parents and/or distributed to students regarding the trip/event

Any staff member who is getting the trip for free must complete a disclosure form if the value is more than $50.00 and send in to the Superintendent’s office before attending the trip.

File: IJOAA-E

Out of State and Overnight Field Trip Checklist

In order to be approved, all conditions must be met

_____ The trip is appropriate for the age group involved.

_____ The trip is reasonable in terms of time, distance and cost.

_____ The trip is not scheduled during the last week of the school year.

_____ Extra-curricular international and domestic field trips occurs mostly during

non-school times _____ school days are approved.

_____ The trip is not scheduled during MCAS testing.

_____ Chaperones are sufficient and cleared to supervise students.

_____ There are sufficient provisions for medical emergencies.

_____ The transportation provider is licensed for passenger transportation by Federal

Motor Carrier Administration. No subcontractor is being used.

_____ Cost associated with optional & voluntary extra-curricular field trips is the

responsibility of the individual students & family.

_____ Parents must be informed they should be able to but not required to purchase trip

insurances. Parents are aware of the different levels of insurances available

and liability should the cancellation of the field trip be needed.

_____ The trip is approved

_____ The trip is approved with the following conditions:_______________________________________________

______________________________________________________________________________________________

_____ The trip is not approved for the following reasons: _______________________________________________

__________________________________________________________________________________________

_____________________________________________________________________________________________

School Committee Chair: __________________________________________ Date: ____________________

Source: Georgetown

Adopted on: April 24, 2008

Revised on: December 14, 2017