Please Complete and Submit to Principal Prior to Trip Date

Form 260-1
Educational Trips
/ Box 700, Rosetown, Sask., S0L 2V0
Phone: (306) 882-2677 Fax: (306) 882-3366
Toll Free: 1(866) 375-2677, / Reference / AP 260 Educational Trips(Curricular and Extra-Curricular)
Revised / September 29, 2014
Level / School/Division
Submit to / Principal/Superintendent of Education
When / According toAP 260 Educational Trip (Curricular/Extra-curricular)

Please complete and submit to principal prior to trip date

Educational Trip Information

Category(Please check)

Day Trip(requires principal’s signature) / Curricular
Overnight Trip (requires principal’s signature) / Extra-curricular
Multiple Overnight; Out of Province Within Canada; Out of Country
(requires Superintendent’s and/or director’ssignature as required)

School Information

School Name / Group
Teacher Name / # of students
Date of Trip / Destination
Departure Time / Arrival Home

Transportation(Please check) (If school bus required please submit approved copy to the Transportation Supervisor)

None Required / Private Vehicle / Charter Bus / School Bus / Airplane
Name of Driver
Chaperone Information / Special High Risk Activities
# of Chaperones / Swimming / Yes / No
Lifeguard on Duty / Yes / No
Does someone possess a First Aid Certificate? / Yes / No / Certified Equipment (i.e. zip line/wall climb) / Yes / No
Does someone have CPR training? / Yes / No / Canoeing / Yes / No
Canoe Certification / Yes / No

Budget Estimate

Anticipated
Student out of pocket expense estimate
Sources of revenue(please cite in box beside)
Has a third party requested a Certificate of Insurance? / Yes / No

By affixing my signature, I am indicating that I have planned an educational trip for students that is relative to curriculum orI have planned an extra-curricular trip as part of the school extra-curricular program. In either case, the planning adheres to the safety standards of the Sun West School Division.

Teacher’s Signature / Date
Principal’s Signature / Date / Approved / Not Approved
Superintendent’s Signature (if necessary) / Date / Approved / Not Approved
Director’s Signature (if necessary) / Date / Approved / Not Approved

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For Detailed Reference see Administrative Procedures 260 Educational TripsCurricular and Extra-Curricular.

Completed and signed Form 260-1 Educational Trips is required for all trips

Day Trip(Teacher insertscheck mark to indicate each step this has been completed)
Low Risk Assessment / High Risk Assessment
Parent consent form on file (Form 260-2 Day Overnight Educational Trip Parent Guardian Consent Letter Template) / Parent consent form on file
Student trip manifest on file / Student trip manifest on file with health card number
Authorized drivers if using private vehicles
(Form 552-2 Driver Authorization Application) / Authorized drivers if using private vehicles
(Form 552-2 Driver Authorization Application)
If using a school bus driver, forward copy of Form 260-1 Educational Tripsto the Transportation Supervisor / If using a school bus driver, forward copy of Form 260-1Educational Tripsto the Transportation Supervisor
Remember: in sport activities – submission of only one form is required for the season / Chaperones and up-to date certifications, i.e. First Aid, CPR, Canoe, Lifeguard, etc.
Teacher’ signature required / Teacher’s signature required
Principal’ signature required / Principal’s signature required
Overnight Trip(Teacher/principal insert check mark to indicate each step this has been completed)
Low Risk Assessment / High Risk Assessment
Parent consent form on file / Parent consent form on file
Student trip manifest on file with health card number / Student trip manifest on file with health card number
Authorized drivers if using private vehicles
(Form 552-2 Driver Authorization Application) / Authorized drivers if using private vehicles
(Form 552-2 Driver Authorization Application)
If using a school bus driver, forward copy of Form 260-1 Educational Tripsto the Transportation Supervisor / If using a school bus driver, forward copy of Form 260-1 Educational Tripsto the Transportation Supervisor
Teacher’s signature required / Teacher’s signature required
Principal’s signature required / Principal’s signature required
Superintendent’s signature required
Multiple Overnight; Out of Province within Canada; Out of Country
(Teacher/principal/superintendent insert check mark to indicate each step this has been completed)
High Risk Assessment
Parent consent, waivers, risk understanding – detailed information required – Refer to Administrative Procedures 260 Educational Trips (Curricular and Extra-Curricular).
Student trip manifest on file with health card number
Individual travel insurance required for out of province/within Canada
Emergency plan outlined, including contact numbers
Detailed schedule circulated to all parents
Teacher’s signature required
Principal’s signature required
Superintendent’s signature required
Director’s signature required (Out of Country)

Certificate of Insurance

This means that the hosting sites sometimes require a Certificate of Insurance from Sun West School Division. This is available from the Superintendent of Business.

Risk assessment

This means that the teacher, principal and superintendent have assessed the activity relative to the Sun West School Division Board of Education protocols, including the Sport/Physical Activity Handbook.

Signature

This means that the teacher, principal, superintendent and director are comfortable that the trip is of sound educational nature relative to the program of the school.

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Excursion Objectives, Schedules & Information

Required for all Curricular trips & needs to be forwarded to principal and superintendent

Curricular Objectives
(Including pre-excursion activities & post-excursion activities, socialization objectives, etc.)

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Safety Information

Required for all trips with High Risk classification and needs to be forwarded to Area Superintendent of Education with responsibility for school operations.

Summarize safety information below: (Practice sessions, evacuation plans, phone availability, emergency contact telephone numbers, etc.)

Number/Gender of Chaperones(excluding teacher)

For Multiple Overnight, Out of Province Within Canada and Out of Country Trips, please include list of Chaperones and their job descriptions

Schedule of Events(Please include dates)

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Excursion Expenses and Revenue

Only required for Multiple Overnight, Out of ProvinceWithin Canadaand Out of Country Trips and needs to be forwarded to Director of Education

Expense / Revenue
Item / Planned Expense / Item / Planned Revenue
Total Expenses / Total Revenues

Other information – if required(student behavioral expectations, )

Teacher’s Signature / Date

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