Field Trip Request Form - Kenton County Schools

KENTON COUNTY FIELD TRIP REQUESTTrip 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___ Kenton County Bus___ Bid Bus Company_______________Company name___ OtherMeals___ Kenton County___ Student Packed___ OtherList:Trip 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):_____ Trip site has been evaluated for potential hazards/special requirements_____ An anticipated Trip 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 listRequest to place on approved listTeacher Signature: _____________________Grade(s): __________ Date: ___/___/___Principal Signature: ______________________________________ Date: ___/___/___

OvernightMealsParent Permission FormMy 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 KentonCounty School District’s Code of Acceptable Behavior.Depart:Return:TimesCostPer Student: $________Per Adult: $________Due Date: ___/___/___TransportationDistrict Bus: ____Other: __________________________________________Kenton County Food ServicesRestaurant / Fast Food :Packed Lunch(Name and location ofeach stop)Date: ___/___/___Lodging:Date: ___/___/___Lodging:If the Kenton County 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 Trip: ___/___/___Location: _______________________________________6 weeks in advance: ( ___/___/___ )_____ Check the district approved field trip list to ensure this location is approved._____ Request 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 “Kenton County Field TripRequest Form”.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