Overnight Trip Request
Please complete this form for any school sponsored over-night trip. Forms must be submitted at least 30 days before travel. Trip itineraries, parent, and student communication should be sent to HR@4j.lane.edu.
School Requesting Trip Approval:
Your answer
Activity, Sport, or Group Traveling:
Your answer
Dates of Travel:
Your answer
Destination including name, address, and phone (if available):
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Purpose of the Trip:
Your answer
This Trip Involves any of the Following:
Required
How many Students will be on the trip
Your answer
How many Adults will be on the trip? Staff? Volunteers?
Your answer
Describe any Impact the Trip has on Other Classes or Programs:
Your answer
If This is a Coed Trip, Please Briefly Describe Sleeping Arrangements:
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Staff Responsible for Students During Travel (including name and phone): minimum 2
Your answer
Describe How the Activities Provide Opportunities for Students to Obtain New Skills, Insights, or Knowledge:
Your answer
Supervision Plans: Please Briefly Describe How Staff and Volunteers will Ensure Student Safety on the Trip:
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All Volunteers and Chaperones have completed the required Chaperone and SafeSchools training.
Individual Responsible for Bed Checks including Time of Check:
Your answer
Please Describe Discipline Plans for Students who Fail to Adhere to Expectations while on Trip:
Your answer
Please Indicate the Date and Time the Student Code of Conduct will be Covered with Students (must be within 24 hours of departure of a trip)
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Time
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Please Indicate the Date, Time, and Method used to Discuss Appropriate Adult-Student Relationships (Boundary Invasion. Must be within 24 hours of departure):
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Transportation (mark all that apply):
Required
Parent Permission Permits Signed and Filed at School.
Student Contracts Completed and Filed at the School.
All Volunteers have Completed the Volunteer Training Including the Safe Schools Videos:
Student Health History Forms are Received and Filed at School:
Funding Sources and/or Account Numbers to be Used:
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Total Estimated Cost of Trip:
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By typing my name below, I am indicating I have Reviewed the district's Overnight Trip Procedures Guide:
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Staff Person Available for 24 Hour Contact
Your answer
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