OVERNIGHT FIELD TRIP PLANS CLASS/ORGANIZATION DESTINATION SPONSOR ORGANIZING TRIP TRIP DATES DATE PLAN RECEIVED

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1 2340C F1/page1 of 8 OVERNIGHT FIELD TRIP PLANS Board-Submitted 1 month prior CLASS/ORGANIZATION DESTINATION SPONSOR ORGANIZING TRIP TRIP DATES DATE PLAN RECEIVED DATE AND TIME LEAVING SCHOOL DAYS MISSED DATE AND TIME RETURNING NUMBER OF STUDENTS INVOLVED NUMBER OF CHAPERONES (Minimum 1 adult chaperone per 10 students) PREPARATIONS FOR THE OVERNIGHT FIELD TRIP: A. Describe how the field trip will enhance the educational curriculum as it relates to that class B. Credit earned No credit earned Not applicable Curriculum Council approved course C. Name of administrator accompanying the students on the trip D. Name of staff personnel and chaperones accompanying the students on the trip (Suggested one (1) staff personnel per thirty (30) students) E. Travel agreements: Method of transportation (Minimum of 1 certified staff personnel on each bus) Use of non-school agency for planning (Reliable references) F. Student, parent, chaperone pre-trip meeting date

2 2340C F1/page 2 of 8 ITINERARY OUTLINE FOR THE OVERNIGHT FIELD TRIP: A. Day by Day Intinerary B. Mode of Transportation C. Cost Fees charged per student Fees charged per adult chaperone Complete disclosure of financial arrangements with travel company: Re: Free trips Other List anticipated reimbursement by school system for adult chaperone. Method of payment D. Describe Accommodations Indoor/outdoor access to rooms Travel accommodations after reaching destination E. Room Security Procedure for supervision F. Expectations of Chaperones (Please attach a detailed narrative as per the outline) BUILDING LEVEL APPROVAL Your educational trip plans as submitted for have been approved. (Date) You may now proceed with making all travel arrangements necessary and complete the itinerary outline for overnight field trips and submit it to the building administrator. (Principal s signature) (Date) COMMENTS OR CONCERNS:

3 2340C F1/page 3 of 8 SCHOOL BOARD APPROVAL Your educational trip plans as submitted for have been approved. You may now proceed with making all travel arrangements necessary. (School Board approval) (Date) COMMENTS OR CONCERNS FROM THE BOARD:

4 2340C F1/page 4 of 8 List of Chaperone Responsibilities for Overnight Trips A. All students are to be accompanied and supervised by the assigned chaperone. B. The chaperone is in charge of and responsible for expected student behavior as per instruction from trip coordinator. C. Chaperones are responsible for attending all scheduled activities unless excused by trip coordinator. D. The chaperone is responsible for knowing their assigned students location at all times. E. Chaperones are required to attend the parent/chaperone/student meeting or meet with trip coordinator individually. List of Student Expectations A. To insure safety and success of the trip; each student is expected to behave responsibly. B. Attendance at all scheduled activities is mandatory. C. The possession or use of alcoholic beverages, tobacco products, and illegal drugs are prohibited. Any student found in violation of this rule, regardless of circumstances, will be sent home immediately at his/her own expense. D. Any student exhibiting irresponsible behavior that endangers the health, safety, or welfare of others will be sent home immediately. E. Students will cooperate with school authorities and chaperones in following all requested instructions.

5 2340C F1/page 5 of 8 Outline for Parent/Chaperone/Student Meeting of Overnight Field Trips A. Day by Day Itinerary of the Entire Trip B. Cost of Trip and Method of Payment C. Student Conduct Expectations *Enforce school handbook procedures of trip Parents and students sign student travel agreement Parents and students sign conduct agreement All necessary individualized forms Authorization of medical treatment Emergency phone numbers Agreement to send student home at their cost if necessary. D. Specific Arrangements for: Proper clothing Expense money Passports Customs E. Name of chaperones and students assigned to him/her. *Expectations for student conduct.

6 2340C F1/page 6 of 8 Overnight Field Trip Student/Parent Travel Agreement The of is (Name of Organization) (School) planning an educational tour on to (Date) (Destination) Point of departure and return:* Means of transportation Owner and operator of transporting equipment Travel agent, if any: The custodian(s)/parent(s) of the student acknowledge(s) receipt of a copy of the school rules and regulations which shall apply to the student during the travel activity. If the travel supervisor elects to send the student home as discipline for violation of the rules and regulations or for any other reason, the custodian(s)/parent(s) agree(s) to pay the expenses of transporting the student home. The student agrees to comply with school rules and regulations during the travel activity. In addition, the student agrees to follow the instructions of the travel supervisor and other participating adults during the travel activity and to assume a fair share of the responsibilities. If the custodian(s)/parent(s) or the student refuses to sign this agreement and if the travel activity is academic, school officials will assign the student to an alternative activity at school. No academic or other penalty will result from non-participation in the travel activity. The custodian(s)/parent(s) of the student consent(s) to the student s participation in the travel activity. On behalf of the student, custodian(s)/parent(s) assume(s) all risks of injury to the student during the travel activity, release(s) Goshen Community Schools and its agents (including volunteers) from any liability for injury to the student during the travel activity, and agree(s) to hold Goshen Community Schools harmless from any and all loss, damages, or expense arising from claims and suits which seek relief on account of injury to the student during the travel activity. Parent Signature** Parent Signature Sponsor Student Signature Principal *If an itinerary or schedule of travel activities is attached, so note; if a schedule of travel activities is attached, this agreement applies to each of the activities on the list. **Unless a decree of a court grants custody to one parent or the other or establishes a guardianship for the student, both parents are custodian and both must sign if both are living. If a decree of a court grants guardianship to two persons, both must sign if both are living.

7 2340C F1/page 7 of 8 Acuerdo del alumno y del padre de familia respecto a excursión con estadía El/La de está planeando una (Nombre de la organización) (Escuela) excursión el día hacia (Fecha) (Destinación) Punto de partida y regreso:* Medio de transporte Dueño y operador del equipo de transporte: Agente de viajes, en caso de haber: El/Los padre(s) de familia o tutor(es) del alumno confirma(n) que recibió/recibieron una copia de las reglas y regulaciones de la escuela, las cuales aplicarán al alumno durante la excursión. Si el supervisor de la excursión optara porregresar al alumno a su casa como medida disciplinaria por violación a las reglas y regulaciones, o por cualquier otra razón, el/los tutor(es) o padre(s) de familia está(n) de acuerdo en pagar todos los gastos de transporte delalumno a casa. El alumno acuerda en cumplir con las reglas y regulaciones de la escuela durante la excursión. Además, el alumno acuerda en seguir las instrucciones del supervisor de la excursión y de otros adultos que participen en dicha excursión, y en asumir su parte equitativa de las responsabilidades. Si el/los tutor(es), el/los padre(s) de familia o el alumno se rehusaran a firmar este acuerdo, y si la excursión fuera de índole académica, el personal administrativo escolar le asignará al alumno una actividad alternativa en la escuela. No habrá ninguna otra sanción por no participar en la excursión. El/Los padre(s) de familia o tutor(es) del alumno da(n) su autorización para que el alumno participe en la excursión. En nombre del alumno, el/los padre(s) de familia o tutor(es)asumirá(n) todos los riesgos de lesiones que el alumno pudiera tener durantela excursión; absolverá(n) a la Corporación Escolar de Goshen y a su personal (incluyendo a los voluntarios) de toda responsabilidad de lesiones ocurridas al alumno durante la excursión, y acuerda(n) en mantener a la Corporación Escolar de Goshen indemne de cualquier y toda pérdida, daños o gastos que surgieran de reclamaciones y litigios que busquen compensación por lesiones al alumno durante la excursión. Firma del padre de familia** Firma del padre de familia Patrocinador Firma del Alumno Director *En caso de encontrar adjunto ya sea un itinerario o un horario de actividades de la excursión, nótese; que si un horario de actividades viene adjunto, este acuerdo aplicará a cada una de las actividades de la lista. **A menos que por decreto de la corte, ésta le otorgue la custodia a un padre o a otro, o que establezca la tutela del alumno, ambos padres son custodios y ambos deberán firmar en caso de que los dos estén vivos. Si un decreto de la corte les ha otorgado la tutela a dos personas, ambas deberán firmar en caso de que las dos personas estén vivas.

8 2340C F1/page 8 of 8 Consensus of the committee which need to preface the application packet. A. All overnight trips must have School Board approval except for the emergency situations when approval will be given by building principal and superintendent. Re: State-sponsored competitions Athletic teams and coaches to state finals Cheerleaders to competition or clinics Music competitions B. Each sponsor must complete the appropriate forms and have approval to building administrator before making trip presentation to the Board. C. Pages 1 and 2 need to be filled out by coach or sponsor and will go to the Board for approval. D. Number of chaperones will be a minimum of one (1) adult per ten (10) students. E. If more than one (1) staff personnel per thirty (30) students is to accompany group, special approval needs to be obtained. Revised 9/14