date completed step 1: initial planning 8 weeks before trip date due: //_ forms needed:...

DATE COMPLETEDSTEP 1: INITIAL PLANNING

8 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS NEEDED: FIELD TRIP DIRECTORY & PRELIMINARY FIELD TRIP PROPOSAL

Use the FIELD TRIP DIRECTORY to complete a PRELIMINARY FIELD TRIP PROPOSAL FORM for STEP 1

Develop a description of all activities; include transportation and eating plans; list unusual aspects of the trip; include all related brochures

Estimate the planned number and ages of participating students and chaperones needed (Standard: 1 to 10 ratio; aquatics: 1 to 8 ratio)

Determine proposed costs and funding Determine and document the educational benefit of the field trip

Identify if the field trip has special hazards, including on/in/near water, in remote locations/hiking, involving animals, and/or outdoor education; avoid high-risk activities

Review field trip plan with principal

Submit to Site Operations for approval STEP 2: PENDING APPROVAL

7 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ Receive an approved PRELIMINARY FIELD TRIP PROPOSAL from Site Operations

School: ________________________________________________________________________________Date of Trip:__________________________________________________________________________Trip Destination: ________________________________________________________________________Site Director: ___________________________________________________________________________

The following list will assist the site director through the field trip process.

Please see the Site Ops Supervisor for specific information regarding each item.

DATE COMPLETED

STEP 3: DETAILED PLANNING6 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS NEEDED: FIELD TRIP ITINERARY, EMERGENCY PROCEDURE, SUB REQUEST FORM & PARENT

FIELD TRIP PACKET

Develop a detailed FIELD TRIP ITINERARY for STEP 1 Contact place being visited to make preliminary arrangements

Evaluate the field trip site for potentials hazards, special requirements of location and activity, and accommodations

Develop an EMERGENCY PROCEDURE for missing students, injury, accident, or impropriate activity; submit to Site Ops Supervisor

Responsibility of Program Supervisor:

Review all contracts and insurance requirements (the Program Supervisor reviews and signs any contracts and all forms)

Responsibility of Program Supervisor: Arrange for transportations If school bus, submit request for transportation If other, check with Site Operations for guidelines

Arrange for food services (if needed)

Identify risks associated with this field trip; discuss with the staff

Sacramento START Field Trip 8-Week Checklist

PG. 1 OF 3

DATE COMPLETED

STEP 3: DETAILED PLANNING6 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS NEEDED: FIELD TRIP ITINERARY, EMERGENCY PROCEDURE, SUB REQUEST FORM & PARENT

FIELD TRIP PACKET

Determine STAFF and Volunteers (PROCESSED & CLEARED) needed: 1-Day Volunteers are not allowed

Ensure adequate number based on the type of activities planned and the age of the students for developmental appropriateness; ratio approved by Site Ops Supervisor

Ensure STAFF qualified for special needs (first aid trained, lifeguard, etc.) Ensure they received Program Volunteer Guidelines

Inform Site Ops Coach of Field Trip

Provide copy of CLEARED VOLUNTEER APPLICATION to Site Ops Supervisor Arrange for needed equipment and supplies, including emergency equipment

Assemble PARENT FIELD TRIP PACKET and submit for approval to Site Ops Supervisor, include :

• Completed Field Trip Permission Slip • Completed Field Trip Reminder Notice • Completed ICE Cards

If a substitute is required, submit a SUB REQUEST FORM to the Site Ops Supervisor Arrange for supervision of students who opt out of the field trip

STEP 4: PENDING APPROVAL 4 WEEKS BEFORE TRIP DATE DUE: ____/____/_____

Receive final Site Operations Administrative approval for PARENT FIELD TRIP PACKET, SUB REQUEST FORM, VOLUNTEER CLEARANCE, ITINERARY, & EMERGENCY PROCEDURE

DATE COMPLETEDSTEP 5: FINAL PREPARATIONS

3 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS: PERMISSION SLIPS, ON-SITE LESSON PLAN, SUB REQUEST FORM

Provide PERMISSION SLIP to Parents/Guardians

Provide to Site Ops Supervisor a complete ON-SITE LESSON PLAN for students who opt out of field trip

Confirm transportation with Site Ops Program Supervisor Confirm food services with Food Services Manager (if needed) Confirm availability of needed equipment and supplies

STEP 6: FINAL PREPARATIONS II2 WEEKS BEFORE TRIP DATE DUE: ____/____/_____

Approval needed from Site Ops Program Supervisor: Meet with school nurse to plan medication needs/dispensing for students; arrange for distribution of special medication on the field trip (trained staff and secured medications)

Provide orientation for volunteers and substitutes; ensure adequate supervision will be available

Confirm food storage with venue and Food Services Manager (if needed) Confirm arrangements with place(s) to be visited (if needed)

Confirm arrangements for special medications with Site Ops Program Supervisor Confirm SUB REQUEST with Site Ops Supervisor Complete 24-HOUR CONTACT LIST


PG. 2 OF 3

DATE COMPLETEDSTEP 7: ASSESSMENT

1 WEEK BEFORE TRIP DATE DUE: ____/____/_____ FORMS: PERMISSION SLIPS, REMINDER NOTICE, STUDENT ROSTERS, STAFF EMERGENCY CARDS, & 24-HOUR

PHONE NUMBER LIST

Confirm there is adequate adult supervision for the trip; check the number of students to staff ratio Ensure adequate transportation On Monday, provide parents/guardians with FIELD TRIP REMINDER NOTICE Provide principal with a FIELD TRIP REMINDER NOTICE

Practice EMERGENCY PROCEDURE for missing students, injury, & accident with staff

Completed STAFF FIELD TRIP EMERGENCY CARD for participating STAFF Make sure the staff/chaperones on the field trip have a 24-HOUR PHONE NUMBER LIST for

administrators, and school office/administrator has (cell) phone number of staff on the trip


DATE COMPLETEDSTEP 9: FIELD TRIP DEBRIEF

1 DAY AFTER TRIP DATE DUE: ____/____/_____ FORMS: DEBRIEF NOTES, 8-WEEK CHECKLIST

After the field trip, evaluate field trip procedures and the activities involved to ensure field trips in the future are safe; Submit DEBRIEF NOTES to Site Ops Supervisor

Submit completed 8-WEEK CHECKLIST to Site Ops Supervisor

DATE COMPLETED

STEP 8: FINAL CHECKDAY OF TRIP DATE DUE: ____/____/_____

FORMS: ROSTERS, ICE CARDS, PERMISSION SLIPS, STAFF EMERGENCY CARDS , 24-HOUR PHONE NUMBER LIST

Confirm there is adequate field trip student to staff ratio

If special equipment or clothing is needed for each student, ensure that it is provided

Get medication for students from the office and ensure medications are secured

Remind principal of field trip

Provide STAFF with finalized STUDENT TRACKING ROSTER FORM

Review behavior and safety standards with students and chaperones before departure, including: Reinforce school rules and expectations The system of accounting for students and the use of the BUDDY SYSTEM & ICE CARDS Review emergency procedures (for injury, accident, or inappropriate activity) Explain what to do if a student gets separated or lost from group

Review with bus driver drop off and pick up arrangements; share contact number with bus driver

PG. 3 OF 3

DATE COMPLETED STEP 6: FINAL PREPARATIONS II2 WEEKS BEFORE TRIP DATE DUE: ____/____/_____

Ensure parental permission is obtained and emergency information is available; Every student has returned a completed FIELD TRIP PERMISSION SLIPS Provide the school office with a copy of the signed FIELD TRIP PERMISSION SLIPS (original of

these forms stay with the site director) A copy of the parent permission/emergency medical form for each student and staff member are

placed in a binder for SD’s use

Review completed PERMISSION SLIPS and create MASTER STUDENT ROSTERS & TRACKING FORM Review EMERGENCY PROCEDURE for missing students, injury, accident, or impropriate activity with staff

Check emergency supplies and essential items for the trip

Use the Field Trip Directory to assist with finding a destination

Preliminary Field Trip Proposal & Field Trip Itinerary MUST be submitted two months prior to the event date

All Field Trips must celebrate the Mission & Vision of Sacramento START

Late and/or incomplete Field Trip Proposals & Preliminary Field Trip Itinerary will not receive approval

All START field trips must be pre-approved by the Site Ops Team and principal prior to any arrangements and announcements to START participants

SITE CONTACT INFORMATION

Today’s date: ____/____/____ Site: ___________________________________________________________________

Site Director: _________________________________ Site Phone: ( ) ____-______ Email: __________________

FIELD TRIP INFORMATION

Field Trip Destination:

________________________________________________________________________________

Address: ____________________________________________ City:_________________ C.A. Zip: _________________

Date of Trip: ____/____/_____ Departure Time: ____:____ p.m. Return Time: ____:____ p.m.

Educational Benefit of the Trip: _______________________________________________________________________

______________________________________________________________________________________________________

INFORMATIONAL CONTACT

Have you made an initial phone call to the field trip destination? Yes No

Contact Person’s Name: __________________________Phone Number: ( ) ____-______ Email:_____________

ADMISSION

Estimated # of Students Attending: ____ Grade Level ____ Adults Attending: ____

Cost per Child $____ Cost per Adult $____ Discounts/Group Rate: Yes No Discount $____

Total Proposed Cost Of Field Trip Admission: $_______________

SUPPER/SNACK

Can students consume food on field trip grounds? Yes No

If no, where will students consume supper/snack? On Campus Off Campus

STUDENT “WHAT TO BRING” LIST:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

STUDENT “WHAT NOT TO BRING” LIST:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

TRAVEL

Means of Travel: Bus Walking Public Transportation Other:____________________________

Field Trip Distance: ____Miles Length of Drive: ____Hours ____Minutes

START 2013-14

Sacramento START Preliminary Field Trip Proposal (1 of 2)

STEP 1

Sacramento START Preliminary Field Trip Proposal (2 of 2) ON-SITE (STAFF NOT PARTICIPATING ON FIELD TRIP)

Staff Names (Non-Participants): ______________________________________________________________________

Substitute Needed: Yes No

FUNDING

How do you plan to fund this field trip?_______________________________________________________________

______________________________________________________________________________________________________

District support provided: Yes No Explain: ____________________________________________________

VISION & MISSION

Describe how this field trip fits into the Vision & Mission of the Sacramento START Program: ______________________________________________________________________________________________________

______________________________________________________________________________________________________

Materials/Resources Needed: ________________________________________________________________________

APPROVAL

Reviewed PRELIMINARY FIELD TRIP PROPOSAL with Principal on: ____/____/____

Principal’s request: __________________________________________________________________________________

______________________________________________________________________________________________________

Principal’s Signature: _________________________________________________ Date Approved: ____/____/____

TIME CONFLICT

Is there a conflict with School’s Release Time: Yes No

Early release approval needed at: ____:____ p.m.

Approval from Principal: Yes No (Principal’s Initials:______)

O F F I C E U S E O N LY

_____ APPROVED Proceed by submitting a FIELD TRIP ITINERARY

_____ DENIED See comments below regarding Policy & Procedure

_____ REQUEST IN PROGRESS Schedule an appointment for more information

Comments:_________________________________________________________________________________________________________________________________________________________________________________________________

Program Supervisor: ____________________________________________________________ Date: ____/____/____

Total Proposed Cost of Field Trip Admission: $_______________ Total Proposed Cost of Field Trip Travel: $_______________Total Proposed of Field Trip (Admission & Travel): $_______________

Superintendent’s Signature: ____________________________Date: ____/____/____ APPROVED DENIED

Budget approved by superintendent: Yes No

Related Brochures/Information Attached? Yes No Does The Trip Involve Any Of The Following: In/Around Water Outdoors Animals

STEP 1

START 2013-14

SITE CONTACT INFORMATION

Today’s date: ____/____/____ Site: _________________________________________________________

Site Director: ________________________ Site Phone: ( ) ____-______ Email: __________________


Field Trip Destination: ______________________________________________________________________

Address: ____________________________________ City:_________________, C.A. Zip: _______________


TIME CONFLICT

Is there a conflict with School’s Release Time: Yes No

Early release approval needed at: ____:____ p.m.

TRANSPORTATION:

Means of Travel: Bus Walking Public Transportation Other:____________________________

# of Adults Riding the Bus: ____ # of Students Riding the Bus: ____

Total # of Participants Riding the Bus: ______

Total Proposed Cost Of Field Trip Admission: $____

STUDENT TO STAFF RATIO

Standard; 1 to 10 aquatics; 1 to 8 Number of Staff/Volunteers needed:_____

Field Trip Staff Names: ______________________________________________________________________

Processed and Cleared Volunteers Names: ___________________________________________________

Copy of Volunteer Clearance Attached: Yes No

SUPPER/SNACK

Can students consume food on field trip grounds? Yes No

Where will students consume supper/snack? _______________________________________________

Food Services Contacted? Yes No

Person Contacted from Food Services: _______________________________________________________

Perishable Items: Yes No Location of Storage for Food on Trip :__________________________

Trash Bags Needed: Yes No Staples: Can Liners-Item #: 518102: $13.39 (50/bx.)

ON-SITE (STAFF NOT PARTICIPATING ON FIELD TRIP)

Staff Names (Non-Participants): _____________________________________________________________

Person In-Charge:___________________________________________________________________________

Substitute Needed: Yes No Attached a Sub Request Form: Yes No START 2013-14

Sacramento START Field Trip Itinerary (1 of 2)

STEP 3

HAZARD ASSESSMENT:

Potential Hazards:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

SUPPLIES AND EQUIPMENT FOR STAFF TO BRING:

Cell Phone

First Aid Kit

Completed Permission Slips

Updated Student Rosters

Site Operations Communication Protocol

24-hour Contact List

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

24-HOUR CONTACT LIST:

Principal’s 24-Hour Emergency Contact #: __________________________________________

District’s Area Specialist Contact #: _________________________________________________

Area Specialist Name: _______________________________________________________

ITINERARY

START 2013-14

Sacramento START Field Trip Itinerary (2 of 2)

ESTIMATED TIME ACTIVITIES

:

:

:

:

:

:

STEP 3

A U T H O R I Z A T I O N

SITE DIRECTOR: X__________________________________________________________ Date: ____/____/_____

COMMENTS: __________________________________________________________________________________

PROGRAM SUPERVISOR: X ____________________________________________________Date: ____/____/_____

APPROVAL: _____Yes _____ No Date: ____/____/_____

COMMENTS: __________________________________________________________________________________

SUB COORDINATOR: X ______________________________________________________Date: ____/____/_____

SUB ASSIGNED: _____Yes _____ No Date Assigned: ____/____/_____

COMMENTS: __________________________________________________________________________________

Sacramento STARTSUB REQUEST FORM

Today’s Date: ____/____/_____

Site Director: ________________________________ Site: _____________________________________

Site Phone: ( ) ____-______ Email: __________________


Field Trip Destination: ______________________________________________________________

Address: ____________________________________ City:_________________ C.A. Zip: _________


SUB REQUEST INFORMATION

Number of Substitutes requesting: _____ Grade Level Needed: Primary Intermediate

Substitute Field Trip Orientation (2-Weeks before trip): ____/____/_____

Time: ____:____ p.m. to ____:____ p.m.

Request Steps:

Request – complete the Sub Request form & submit for approval 6-weeks before field trip

1. Site Director Request– complete request section for field trip & submit with payroll

2. Program Supervisor Authorization – complete approval for Sub Request & Submit to Sub Coordinator within 1 week; provide Site Director with copy

3. Sub Coordinator Authorization – complete approval for Sub Request & email site staff of approval or denial within 2 weeks

Be Advised: All Requests must be submitted 6- weeks in advance to assign a substitute; Field Trips not within ratio will jeopardize your fieldtrip!

2013-14

STEP3

Academics:1 hr

Rotation 1: 45-60 min

Rotation 2: 45-60 min

Transition

Homework

Program Leader

Curriculum:Enrichment

Team Building

Recreation Aide

Curriculum: Nutrition

Fitness

PLSame

activity – Modified for age group

RA Same

activity – Modified for age group

Description Of Activities

TRANSITIONS(Between

components)

Play energizer games, Review math facts, Recite group chants

Do warm-up games, Stretches, Rhyming

games

SD Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

It is essential to provide quality programming for students that are not participating in the fieldtrip. The chart below should serve as a lesson plan that breaks the program time into transitions: academics, rotation 1 and rotation 2. Site Directors need to describe the activities taking place on the field trip day and debrief with the staff in charge, so they

are fully aware of their responsibilities.

START 2012-13

Sacramento STARTOn-Site Program Plan for Non-fieldtrip Participants

STEP5

Sacramento START Field Trip Permission Slip

Page 1 of 2

Please return this permission slip to START Staff by: ____/____/____

Our START program will be going on a Special Field Trip soon. We will be leaving the site and traveling on this trip during program time. After you read the information below, regarding the field trip, we ask you to sign and date the consent form for you child to join us on this rewarding event. If you have any questions or concerns, contact the

Sacramento START staff.

FIELD TRIP PLANSite Name: __________________________________________________________________

Field Trip Location: __________________________________________________________________

Field Trip Date/Day: __________________________________________________________________

Field Trip Site Departure: ___________________________Field Trip Site Arrival: _____________________

Purpose of Fieldtrip: __________________________________________________________________

Site Director’s Name : __________________________________ Phone #:________________________

Transportation for this activity will be provided by: Bus Walking Distance: _________ miles

Students will have snack/supper On Campus Off Campus

Food will be provided at (time): _________ by: ______________________________________________________

Students will need to bring money Yes No Purpose for Money:______________________________________

PARENT/GUARDIAN NEEDS TO COMPLETE THE INFORMATION BELOW

I hereby give my permission for (Name of Student)__________________________to attend the field trip on the scheduled date and time listed above.

I received a detailed itinerary of the trip Yes No

I received a list of things the student should/should not bring Yes No

MEDICAL/ EMERGECNY INFORMATION

Student's Home Phone # _________________________Date of Birth ____/____/____ Grade: ____

Student’s Address: _________________________________________________________

Does the student have any medical or physical condition, medication information, or allergies which could interfere with the student’s safety? Yes No

If yes, please describe: _____________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________

PARENT/GUARDIAN EMERGENCY CONTACT INFORMATION:

Parent/Guardian Name: ________________________________________________

Work Phone #: ____________________________________________________

Home Phone #: ____________________________________________________

Cell Phone #: ____________________________________________________

STEP 3&5

START 2013-14

Sacramento START Field Trip Permission Slip

Page 2 of 2

INFORMED CONSENT

As the parent/guardian of the above named student, I have read the field trip itinerary and I understand that there are risks of physical injury associated with participation in these activities.

I authorized qualified emergency medical professionals to examine and in the event of injury or serious illness, administer emergency care to the above name student. I understand every effort will be made to contact me to explain the nature of the problem prior to any involved treatment. In the event it becomes necessary for the staff-in-charge to obtain emergency care for my student, neither he/she nor the Sacramento START Program assumes financial liability for expenses incurred because of the accident, injury, illness and/or unforeseen circumstances.

I understand these activities are an extension of the school education program and student conduct is to be in accordance with the school’s published rules and regulations.

I assume full responsibility for the above participant’s behavior and agree to pay for all damages to property and/or persons caused by the participant mentioned above.

I agree to release and discharge in advance the City of Sacramento their officers, employees and agents, from any and all liability for personal injury, death or property damage connected with my participation even though that liability may arise out of their negligence or carelessness.

Signature of parent/guardian: _____________________________________ Date: ____/____/____

Printed name of parent/guardian: ____________________________________________________

Special Instructions for my child:_____________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

START 2013-14

STUDENT PLEDGE

I pledge that my conduct will, at all times, reflect credit upon myself, my parents, and my school. I understand that the school rules of conduct apply while on the trip.

Signature of Student:: _________________________________________ Date: ____/____/____

In the event of an emergency (injury, illness, unforeseen incident), I wish the following person to be notified in case I cannot be contacted:

Name: _______________________________ Relationship: _______________________

Phone #: _______________________________ Alternate Phone #:____________________

Sacramento START Field Trip Reminder Notice

FIELD TRIP PLAN

We would like to remind you about our field trip by providing this reminder notice that contains all the trip details. If you haven’t done so, please complete the field trip permission form provided by the site

director and return it as soon as possible before the deadline date.

Site Name: __________________________________________________________________

Field Trip Location: __________________________________________________________________

Field Trip Date/Day: __________________________________________________________________

Field Trip Site Departure: ___________________________Field Trip Site Arrival: _____________________

Purpose of Fieldtrip: __________________________________________________________________

Staff Contact Name : _________________________________ Phone #:_________________________

Transportation for this activity will be provided by: Bus Walking Public Transportation Other:____________

Field Trip Distance: _________ miles

Students will have snack/supper On Campus Off Campus Food will be provided at (time): _________ by: ______________________________________________________

Students will need to bring money Yes No Purpose for Money:_____________________________________

START 2013-14

ESTIMATED TIME ACTIVITIES

:

:

:

:

:

:

:

ITINERARY LIST OF ITEMS

TO BRING/ NOT TO BRING:

BRING…

NOT TO BRING…

STEP 3&7

24-HOUR CONTACT LIST

Ken McCulloch: 916.825.7166 (Cell) 916.808.5264 (Desk)

Joanne Marson: 916.826.9256 (Cell) 916.808.6089 (Desk)

Brian Fitzgerald: 916.835.7991 (Cell) 916.808.6197 (Desk)

START Office: 916.808.6197 (Luz/Front Desk)

Principal’s 24-Hour Emergency Contact #: _________________________________________

District’s Area Specialist Contact #: ________________________________________________

Area Specialist Name: _______________________________________________________

Site Ops Supporting Coach #: ______________________________________________________

Coach’s Name: ______________________________________________________________

Sacramento START 24-Hour Contact List

In case of an emergency, it is important to provide a complete 24-hour Contact List to participating staff and non-participating staff.

In an Emergency…DIAL 911

Police (Non-Emergency): __________________________________________________________________

Fire (Non-Emergency): ____________________________________________________________________

Step 6

SUPPLIES AND EQUIPMENT FOR STAFF TO BRING:

Cell Phone

First Aid Kit

Completed Permission Slips

Updated Student Rosters

Site Operations Communication Protocol

24-hour Contact List

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

Sacramento START SUPPLIES AND EQUIPMENT FOR STAFF TO BRING

Sacramento START Program Field Trip

In Case of an Emergency Card (I.C.E. CARD)

My START Program:(Insert School Name Here)

My Site Phone Number: (Insert Phone Number Here)

My Site Director/Leader Name:(Insert SD/Leader’s Name Here)

This I.C.E Card must be carried by student at all times.

I.C.E. Card (BACK SIDE)

(1) IN CASE OF AN EMERGENCY:

Contact (SD Name Here & Site #) (2) IN CASE OF AN EMERGENCY :

Locate a uniformed START Staff Member

or Police Officer(3) IN CASE OF AN EMERGENCY:

Notify Ken McCulloch(916) 825-7166

Sacramento START – (916) 808-61975735 47th Avenue – Sacramento, CA 95824

Sacramento START Program Field Trip





This I.C.E Card must be carried by student at all times. Sacramento START Program Field Trip





This I.C.E Card must be carried by student at all times.















I.C.E. CARDS INSTRUCTIONS: An ICE Card is a card each participant carries all day on the fieldtrip. If a student is in an emergency situation and needs to communicate with the field trip personnel or police, the ICE Card holds all the important information required by

first responders to ensure our students needs are properly and safely met. Please complete the areas in grey font. Once the information is completed, change the font to black. On the day of the fieldtrip, provide an ICE CARD to all students attending

the fieldtrip.

START 2013-14

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=2mYdOIfK6gurnM&tbnid=A8gyaqZAI6a1RM:&ved=0CAUQjRw&url=http://www.canstockphoto.com/illustration/emergency.html&ei=VDCmUcPhM4WbiQKb9oCIBg&bvm=bv.47244034,d.cGE&psig=AFQjCNEuEoI_b9wozPYVqCY-aaQkoludlg&ust=1369932232977203



Sacramento START Field Trip Master Student Roster Form

START 2013-14

PRINT CLEARLYSTUDENT NAME

PRINT CLEARLYSTUDENT NAME

1. 21.

2. 22.

3. 23.

4. 24.

5. 25.

6. 26.

7. 27.

8. 28.

9. 29.

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20. 40.


Educational Objective: ______________________________________________________________________

Location: ___________________________________________________________________________________

Program: _____________________________________ Cluster: ____________________________________

Approved by Site Director: ____________________________________ Date: _______________________

STEP6

Sacramento START Field Trip Student Tracking Roster

START 2013-14


Educational Objective: __________________________________________________________________________

Location: ____________________________________________________________________________________

Staff Member’s Name : ___________________________________ Grade : ______ Number of Students: ______

Leaving the School Do a roll call, and make sure you have everyone's permission slip before boarding the bus. Give staff a completed Student Tracking Roster. These are the students the

staff is responsible for. One staff to every group of ten kids is much safer than one staff to 20 kids. Do a roll call once everyone is on the bus at school. Make sure all your staff is on board, as well.At the Destination Give every staff a whistle. This will allow them to get the students' attention. Matching shirts are another way to keep an eye on students in your group. Bright colors make

it easier to recognize a group member as you scan a crowd. Make sure all staff have a watch, and choose points where groups can periodically meet up. Heads should be counted to make sure participants haven't been lost.Leaving the Destination Set a time to meet at a location at the field trip site. Once everyone arrives, do another roll call. At this point, it is safe to line everyone up and get on the bus. Once again,

do another roll call and check to see that everyone is on board.

NUMBER OF

STUDENTS

BUDDY SYSTEMPair the students off with a buddy for an extra degree of accountability. Instruct them to stay with their buddies throughout the entire trip and to

let an adult supervisor know if the buddy wanders off or gets hurt.

PERMISSION

SLIP

ON BUS AT SCHOOL

OFF

BUS AT DESTINATI

ON

ON BUS AT DESTINATI

ON

OFF

BUS AT SCHOOL

STUDENT NAME

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

STEP6

Sacramento START Staff Field Trip Emergency Card

NAME OF EMPLOYEE: Address:

City: State: Zip:

Home Phone #

Cell Phone #

Email Address:

Birth Date:

EMERGENCY CONTACTSIn the event of an emergency these individuals may be contacted.

Name: Relationship:

Home Phone # Work Phone # Cell phone #

Name: Relationship:

Home Phone # Work Phone # Cell phone #

DR. INFORMATION

Physician: Phone Number:

Insurance Name: Medical #

Notes:

SIGNATURE: DATE:

STEP 7

START 2013-14

Sacramento START Field Trip Reflection for Students

We’re going on a Field Trip! What do you think you’ll

see? BEFORE THE TRIP AFTER THE TRIP

I THINK I WILL SEE… I DID SEE…

I AM LOOKING FORWARD TO… MY FAVORITE PART WAS…

START 2013-14

date completed step 1: initial planning 8 weeks before trip date due: ____/____/_____ forms needed:...

Documents

date completed step 1: initial planning 8 weeks before trip date due: //_ forms needed:...