OLYMPIA
SCHOOL
DISTRICT
FIELD TRIP REQUEST
III CHECK
IF OV.ERNIGHT
GROUP (DEBATE, BAND, ETC.)
CELL PHONE CONTACT
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# TEACHER
PHONE @ DESTINATION
CHAPERONES
M:
F:
# PARENT
1.
AOO'L CONTACT
CHAPERONES
PHONE
TRANSPORTATION
HOUSING
FOOD
OTHER
COSTS
BUILDING BUDGET Oz.oD2-,S'/m-v--{~()
ACCOUNT #
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STUDENT
BODY
ACCOUNT
#
$
$
I WILL GIVE THREE (3) DAYS' WRrTTEN NOTICE TO STAFF PRIOR TO TRIP.
I WILL ACQUIRE A PERMISSION SLIP FOR EACH STUDENT: LEAVE ONE COPY W IOFFICE;
RETAIN ORIGINAL FOR TRIP.
I HAVE HAD MY CURRENT CLASS LIST REVIEWED FOR HEALTH CONCERNS AND HAVE ANY NEEDED EMERGENCY ACTION PLANS.
I HAVE BEEN TRAINED BY THE SCHOOL NURSE TO ADMINISTER MEDICATIONS.
I HAVE A FIRST AID KIT FOR EVERY VEHICLE.
SCHOOL NURSE IS AWARE OF TRIP AND WILL REVIEW STUDENT LIST FOR HEALTH CONCERNS a MEDICATIONS PRIOR TO DEPARTURE.
p;\.forms\fipicf
trip r'?quesl: sept. 20 i 1.dor:;r.
September 201 i
Olympia School District
Olympia Regional Learning Academy
Activities off-Campus Trip
Supervision Plan
Please complete the boxes below providing a detail plan for direct supervision of students during each phase of
re uested activity. Add additional sheets, if needed.
Program/Activity Schedule: (if multiple days, list by day)
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During Program/Activity:
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night, etc)
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~012
Imagine Tomorrow Travel Itinerary- May 29, 20 15-May 31, 2015
Olympia Regional Learning Academy
Advisor: Karina Champion
Date
Time
From
To
5/29/2015
9:00 a.m.11:30 a.m.
12:00 a.m.3:00p.m.
ORLA
Ellensburg, WA
Ellensburg, W A
WSU, Pullman
CIannon!CIoldsworthy
residence halls
CIannon!CIold.sworthy
residence halls
5/29/2015
5/29/2015
3:00p.m. 4:00p.m.
CIannon!CIoldsworthy
residence halls
5/29/2015
4:00p.m.
Gannon!CIoldsworthy
residence halls
5/29/2015
5:30p.m.
6:00pm.
Conference room
Mode of
Transport
Personal
Vehicle
Personal
Vehicle
Walking
Walking
.
CIannon/CIoldsworthy
residence halls
Walking
CIannon!CIoldsworthy
residence halls
Conference room
Walking
Walking
-
CIannon!CIoldsworthy
residence halls
CIannon!CIoldsworthy
residence halls
Setup entry and
present to judges
11:30 a.m.
11:30 a.m.
Conference room
CIannon!CIoldsworthy
residence halls
Walking
Lunch
CIannon!CIoldsworthy
residence halls
Conference room
Walking
Conference room
CIannon!CIoldsworthy
residence halls
Walking
View project and
complete
presentations to
judges,
Ice cream social
with judges,
Break down and
take proi ects to car
Dinner (5:30-7) and
prep for awards
ceremony (7-7:40)
Gannon!CIoldsworthy
residence halls
Conference room!
CIannon!CIoldsworthy
residence halls
Walking
6:30a.m.
5/30/2015
5/30/2015
6:30 a.m.7:20a.m.
7:20a.m.
5/30/2015
1:00 p.m.
1:00 p.m.
5:30p.m.
5/30/2015.
5:30p.m.
7:40p.m.
5/30/2015
Lunch stop:
Ellensburg, W A
Check-in to
competition and
residence hall
Check-in to
competition and
residence hall
Setup entry
CIannon!CIoldsworthy
residence halls
5/30/2015
Activity
7:40p.m.
10:30 p.m.
Dinner, then prep in
co=on
room, then
sleep-lights out
!0:00p.m.
Breakfast
Awards ceremony