Excursion Approval Application Form

Name of Kindergarten
Date of Excursion
Alternative Date
Please list all destinations being visited on your excursion - and include a contact phone number for the venue and cell phone number being taken by staff.
Do you have any “Plan B” destinations?
(Eg if you can’t have morning tea at your planned venue? / If Yes - please identify.
(Note - if you use any alternative venue on the day, please advise the Association at the time)
Is there any open water accessible at any of these destinations? / YesNo
Note - ratio of 2:1 is required if your excursion is going near open water
Departure Time: / Approx time of return:
Learning Outcomes for the Children
Type of Transport
Please provide name/contact number of bus company
Ratio of Adults:Children on Excursion(teacher responsible is not included in ratio)
Ratio of Adults:Children at Kgtn (if Applicable)
I agree that the Hutt City Kindergarten Excursion Policy and ECE Regulations will be adhered to. / Signed by Head Teacher

(email form to Senior Teacher)

Actioned by Senior Teacher:

Approved/Declined

Signed:

Kindergarten Excursion – Hazard Action Plan

The Head Teacher must make sure that all members of the group are made aware of the hazards that may exist on your excursion to the:

Hazards / Strategies

Confirmation from Kindergarten

Complete the section below and return this form to the Association Office before your excursion.

Kindergarten
Excursion Date
We have identified potential hazards and will take all practicable steps to address these items. All supervising adults will be advised of these hazards before the excursion.
We have completed an Excursion Planning Checklist for this excursion.
Signature of Head Teacher
Date

Parental Permission for Excursion Form

Destination:______

Date of Excursion: ______

Time of Excursion: ______

Adult/Child Ratio: ______

Mode of Transport: ______

Cost: ______

Purpose of Excursion:

______

______

General Assessment of Risk:

______

I give permission for my child to attend this excursion.

Signed: ______

Excursion to:

I give permission for my child to travel by:

and attend this excursion on:

We have sighted the ‘risk management form’ located behind this permission form.

The ratio for this trip is: therefore we require: parent helps.

Child's Name / Sign for Permission / Parent Help (tick if you can help)

Vehicle Approval Form

Destination and date of excursion: ______

Parent\whanau\caregiver name: ______

Licence plate number:______

Warrant of Fitness:______

Registration expiry date:______

Driver’s licence number:______

Number of seats available:______

Driver’s signature:______



For office use only

Names of children/adults

______

______

______

______

______

Adhered to Association policies:  Yes No

Does every child have an approved

safety restraint for use in this vehicle?  Yes No

Head Teacher Signature: ______Date: ______

Date / Adults/Teachers
Contact phone# / Children / Destination / Rationale
(ie learning outcome) / Parents Informed? / Hazards
(what might happen/cause harm?) / Strategies
(how we will minimize hazards) / Ratio

Excursion Policy Page 1Policy Number 4.050

8 May 2017