Field Trip Request Form - Kenton County Schools
Field Trip Request Form - Kenton County Schools
Field Trip Request Form - Kenton County Schools
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KENTON COUNTY FIELD TRIP REQUEST<strong>Trip</strong> Date: ___/___/___ Location: _______________________________________Depart: ________AM/PM Location Contact Person/Number:____________________Return: ________AM/PM ` ____________________#Students: ________#Teachers:________#Parents: ________Adult/Student Ratio: ________Additional Staff:_________________________________________________________________________________________________________CostPer Student: $________Per Adult: $________*Additional: $________*explanation:Transportation___ <strong>Kenton</strong> <strong>County</strong> Bus___ Bid Bus Company_______________Company name___ OtherMeals___ <strong>Kenton</strong> <strong>County</strong>___ Student Packed___ OtherList:<strong>Trip</strong> Purpose and Core Content Connection:Special Student Circumstances (medications, accessibility, students not participating andalternate activity, other):The following items have been completed or are in process (initialed by trip planner):_____ <strong>Trip</strong> site has been evaluated for potential hazards/special requirements_____ An anticipated <strong>Trip</strong> Itinerary is attached._____ Funds have been secured for indigent students._____ Background checks for chaperone approval have been initiated. The final list ofapproved chaperones will be provided to the principal no less than three (3) daysprior to the trip._____ Board approval has been initiated for this trip because it is: (circle all that apply)More than 50 miles Overnight Not on approved list<strong>Request</strong> to place on approved listTeacher Signature: _____________________Grade(s): __________ Date: ___/___/___Principal Signature: ______________________________________ Date: ___/___/___
OvernightMealsParent Permission <strong>Form</strong>My child, __________________________________________, has permission to go with his/her class to___________________________________________________ on ___/___/___ for the purpose of_______________________________________________________________________________. All district andschool policies will be followed on this trip including: chaperone assignments for both day and overnight trips,adult/student ratios, transportation guidelines and behavior expectations/dress codes as outlined in the <strong>Kenton</strong><strong>County</strong> School District’s Code of Acceptable Behavior.Depart:Return:TimesCostPer Student: $________Per Adult: $________Due Date: ___/___/___TransportationDistrict Bus: ____Other: __________________________________________<strong>Kenton</strong> <strong>County</strong> Food ServicesRestaurant / Fast Food :Packed Lunch(Name and location ofeach stop)Date: ___/___/___Lodging:Date: ___/___/___Lodging:If the <strong>Kenton</strong> <strong>County</strong> Board of Education determines that world, national, or local events pose a potential threat tostudent safety, field trips will be cancelled. In such a cancellation, the Board will not authorize the use of district orbuilding funds to reimburse any expenses not covered by cancellation insurance. All losses will be assumed by theparent/guardian. Please initial to indicate that you have read and understand the conditions of this clause. ______Ifchecked, it is recommended that the parent/guardian secure cancellation insurance. Information attached.________(parent/guardian initials).Should there develop a medical emergency that requires attention beyond first aid, every attempt will be made tocontact the parent or guardian via the numbers listed below. However, in circumstances where timing is criticaland/or communication problems develop, a student’s life could be threatened by lack of medical attention. In orderto avoid circumstances of this nature, please complete the following statement.In cases of a medical emergency, as deemed by a physician and according to the procedures described above, I, asthe parent/legal guardian, do hereby give my consent for the administration of medical treatment, including dental,medicines, inoculation, and/or surgical procedures deemed necessary to my child’s health and safety.Home Phone: _______________Mom (work): _______________(cell): _______________Address: ____________________________________________Dad (work): _______________(cell): _______________Family Doctor:_____________________ Phone:___________ Hospitalization Card #_______________Name of Medical Insurance Carrier:_______________________________________________________Allergies and/or reactions to drugs:________________________________________________________Medications currently taking:_____________________________________________________________Medication needed on this trip ___________________________________________________________PARENT/GUARDIAN SIGNATURE:_____________________________________________Failure to provide a complete, signed form will exclude the student from participation. Phone permission willnot be accepted._____________________________________________________(Principal’s signature)____________________________________________________(Teacher’s Signature)
SCHOOL LEVEL FIELD TRIP PLANNING CHECKLIST(All timelines are recommendations only.)Date of <strong>Trip</strong>: ___/___/___Location: _______________________________________6 weeks in advance: ( ___/___/___ )_____ Check the district approved field trip list to ensure this location is approved._____ <strong>Request</strong> Board approval for any trip not on the approved list, overnight, or over 50 miles from theBoard Office even if already on the approved list. Use the official “<strong>Kenton</strong> <strong>County</strong> <strong>Field</strong> <strong>Trip</strong><strong>Request</strong> <strong>Form</strong>”.4 weeks in advance: ( ___/___/___ )_____ Send out student permission forms._____ Submit bus request to transportation department and appropriate paperwork to buildingbookkeeper.2 weeks in advance: ( ___/___/___ )_____ Confirm receipt of student permission forms, authenticate signatures, and send duplicate noticesas needed._____ Confirm parents requesting to chaperone are on the approved list and begin assignments ofchaperones to students (adult/student ratio)._____ Confirm transportation arrangements with appropriate provider._____ Consult with cafeteria manager on lunch arrangements, including number of students out of thebuilding if lunch is not provided through district food services.1 week in advance: ( ___/___/___ )_____ Review permission slips with school nurse for medications and/or specific adaptations._____ *Confirm trip specifics and student numbers with principal or designee.Secure initials of Principal or designee.On the day of the trip be sure to:___ Provide chaperone orientation___ Take classroom emergency kit___ Post attendance___ Take student permission slips___ Take student lunches___ Take student medications___ Take required payments___ Give office copies of student permission slips