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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

 

                                                                                        

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