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

Destination: Bow Habitat Station

Address: 1440 17a St. SE

Calgary, AB. T2G 4T9

Service Provider Contact Name and Phone:

Bow Habitat Station
(403) 297-6561

Transportation Notes or Special

Requests/Requirements:
Bus must be accommodating to handicapped
students with a wheelchair ramp.

Destination assessed and adequate: Yes No

If overnight accommodations acceptable: Yes No
N/A
Route assessed and adequate: Yes No
Trip duration appropriate: Yes No

School calendar checked for conflicts: Yes No

Parent Info Meeting planned: Yes No N/A
Equal Access Assured for all Students: Yes No

Method of Transportation:
Walking
School owned bus
Rental vehicle / Charter bus
Public Transport
Provided by service provider
Other:

Estimated Cost of Trip: $416

Supervisors:

Ratios Info:

Teacher in Charge: Josue Ramirez

List all teachers supervising:

Min 1:8 (younger than K)

Cell #: (403) 555-0123
Cell #s:

Emma Krammer, Michael Grier

(xxx) xxx-xxxx, (xxx) xxx-xxxx

Josue Ramirez, Katherine Yurkovich

Teacher in Charge has confirmed volunteers
have completed Volunteer Clearance process:

Payment Info: (i.e. invoice coming, call who to pay

with credit card)
Source(s) of Funds: Class contributions

Min 1:10 (K Gr 6)

(xxx) xxx-xxxx, (xxx) xxx-xxxx

*Parent volunteer names and cell numbers
must be confirmed before date of field trip

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

*Due to insurance regulations, parent volunteers

cannot be transported by school busses.

Primary First Aider: Josue Ramirez

Certificate Held: First Aid & CPR

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)?

Fish Hatchery Tour (30 mins)

Fish Feeding (15 mins)
Trail Trekking (35 minutes)
Wetland Wonders (45 minutes)
Discover Center (1-2 hours)

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.

4. What follow up activities will occur?

Students will use this information to create an artistic rendition of their bridge plan, and include their
new knowledge of ecosystems. This assignment will be a summative assessment to check their
understanding of the unit plan so far.

Notes for parent letter:

Inform parents about the activities that students will participate in at station,
the method of transportation, and the $16 fee from each student.
Safety Guidelines
Yes, I have reviewed and applied the revenant sections of the Employee Manual
Safety Plan: Briefly describe the assessment and preparation that has occurred regarding the

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.

Proposal Attachments Checklist: (check all applicable)

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:

Print Name of Teacher in Charge:

Josue Ramirez
Print Name of Authorized Administrator:
Mrs. Locksmith
Print Name of Additional Approval (as
needed) N/A

Date:

Signature:

Date:

Signature:

Date:

Signature:

At completion of field trip, send the following to office for archiving:

Finalized trip plan
Signed parental consent forms
Names of no-shows
Any other applicable paperwork