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Single Activity
PLEASE READ AND REVIEW THE CBE OFF-SITE ACTIVITIES PROCEDURES MANUAL PRIOR TO COMPLETING THE PROPOSAL
Once the Principal has approved this off-site activity:
The Principal should e-mail a copy of the proposal (do not send support documents) to A Online @cbe.ab.ca at least
one (1) week prior to the trip.
SCHOOL: UNIVERSITY SCHOOL
PHONE:
FAX:
AREA:
PRINCIPAL: DR. WENDY FREEMAN
403-555-7480
403-5551
7489
DESTINATION (VENUE):
DEPARTURE DATE (dd-mth-yr): RETURN DATE (dd-mth-yr):
Fairview Hutterite Colony
05-Apr-16
05-Apr-16
DEPARTURE TIME: 8:45AM
RETURN TIME: 12:30PM
AREA OF STUDY (AS DEFINED IN THE PROGRAM OF STUDIES):
TYPE OF TRIP:
Health and Wellness, Social Studies, Science
GRADE 5 HUTTERITE COLONY TOUR
GRADE LEVEL (Please check all that apply):
# OF STUDENTS :
MALE:
14
ECS
1
2
3
4
5
6
28
FEMALE: 14
7
8
9
10
11
12
SP
Contact phone number of the teacher-in-charge during the field trip: 403-555-0493
Facility: Fairview Hutterite Colony
Cell No. 403-555-3818
SUPERVISION
STAFF/
VOLUNTEERS
Teacher-inCharge
(1 TIC only)
Staff:
#1
(list) of Staff
Julie Hur
Volunteers:
#2
(list)of
Volunteers
Christine
Leach
Alanna
Kennard
GENDER
WHAT
CURRICULUM
AREAS ARE
TAUGHT?
DATE
OF LAST
VISIT TO SITE:
WILL YOU BE
PRESENT FOR THE
ENTIRE TRIP? IF NOT,
SPECIFY SCHEDULE.
Yes
Female
English
Language Arts
03/25/2016
Female
Science
03/25/2016
Yes
Female
N/A
N/A
Yes
Teacher in Charge has confirmed volunteers have completed the Volunteer Clearance process.
A_Single_Proposal.doc
Off-site Administrative Assistant
LIST RELEVANT
CERTIFICATIONS
(E.G. LEVEL OF FIRST AID,
ETC.
AND EXPIRY DATE)
(APPENDIX 2 AND CHAPTER 7)
Yes
No
Supervision
Students must be supervised at all times by CBE Staff and/or Volunteers.
1
List the training, skills, knowledge and experience related to the activities and supervision in general, that support the
choice of each supervisor. List each individual separately, including the Teacher in Charge. If specific volunteers are
not known, please provide the general criteria. E.g. knowledge of students, first aid, etc. Alanna Kennard, English
Language Arts, Knowledge of students needs academically, medically and behaviourally, Julie Hur, Science teacher,
Knowledge of students needs academically, Christine Leach, Volunteer Teacher Inglewood Bird Observatory Coordinator, First
Aid Certification and experience with running weekly field trip experiences with CBE staff.
How has such information and responsibilities been communicated? (e.g. meetings, manual, written communication)
Meeting and written electornic communication.
Will the larger group be split into smaller groups at any time during the off-site activity?
Yes
No
4
5
Yes
Yes
No
No
Yes
Yes
No
No
A_Single_Proposal.doc
Off-site Administrative Assistant
1. What role does the service provider have with regards to the preparation of the off-site activity?
To ensure the buildings are ready for the tour.
2. What is the role of the service provider during the off-site activity?
To direct the tour and ensure it is age appropriate, answering student's questions, etc.
RESTRICTED ACTIVITIES
Please indicate any and all of the following activities that are planned for this Off-Site Activity. By checking the boxes
below, I am verifying that I have read the information on this Restricted activity in the Offsite Manual.
Acitivity/ies
Canoeing-Flat Water
Canoe Tripping-Flat Water
Canoeing-Moving Water
Cycling
Ice Skating
Fine and Performing Arts
Hiking
A_Single_Proposal.doc
Off-site Administrative Assistant
Kayaking-Flat Water
Kayaking-Moving Water
Kayaking in Sheltered Water
Mountain Biking
Sailing
Skiing-Cross Country
Students will take part in a field trip excursion to the Fairview Hutterite Colony to see alternative lifestyles and cultures
present in Alberta. The students will be exposed to witnessing where their food comes from and the work that is involved
in gathering that food - collecitng eggs from the hens, milking cows, etc.Students will explore outcomes related to social
studies, especially when considering the histories of people who live in Canada and their lifestyles. The colony experience
will demonstrate the concept of "farm to table" when discussing where our food comes from.
Itinerary:
Specific Activity/Brief
Description:
Location:
A_Single_Proposal.doc
Off-site Administrative Assistant
ACTIVITY
Transportation
Weather
A_Single_Proposal.doc
Off-site Administrative Assistant
Precautions Taken
Consent and Acknowledgement of Risk Forms collected for
each student.
Allocated additional CBE staff/ Volunteers to accompany the
students on the day trip Consent and Acknowledgement of
Risk Forms collected for all Volunteers.
Met with the site supervisor and and inspected the grounds
in March to ensure the safety of the entire facility.
Requirements Checklist
Complete and attach the following forms to the template when submitting to the Principal for approval
Consent and Acknowledgement of Risk - Student
Consent and Acknowledgement of Risk Volunteer
Parent letter
Swimming Ability Form (if applicable)
Detailed Itinerary: Provide detailed itinerary from sun up to sun down.
Teacher Summary: Use Teacher in Charge Summary form found in the Off-site document library on the website.
Attach the completed Service Request when using a Service Provider.
Trip Preparation
As the Teacher-in-Charge:
What preparation have you undertaken to gain familiarity and check the appropriateness of the site (terrain, equipment,
buses, etc.)?
On March 25 the site was visited. Indoor and outdoor programming was undertaken, as well as a full inspection of the site was
performed with the facility's site supervisor. Staff were given the full tour that the students will take.
What effects will weather have on this off-site activity?
Minimal, as the students will be outside only to move between the buildings on the tour. the instrumental clinics and guest
conductor clinic both occur indoors.
How have you prepared the students skills, and knowledge and readiness for the off-site activity?
Yes, the students have obtained pre-learning instruction, and have examined a bit of information regarding the lifestyle of
Hutterites and what to expect.
How have you ensured that parents and students have received all pertinent information regarding this trip, including
hazards and emergency procedures?
The Parent Letter and Consent and Acknowledgement of Risk Form was given to each student, electronic communication
regarding the off-site activity answering any questions or inquiries pertaining to the off-site activity occurred, and in-class direct
communication with the students took place.
A_Single_Proposal.doc
Off-site Administrative Assistant
Communication devices used for emergency contact (includes cell phones, 2-Way Radios, etc)? Camp Main Phone Line & Cell Phone
Are you relying on a service provider to meet the first aid ratio? No
First Aid kit required (type): No. 2 Kit with CBE Incident Report 3 blankets
Steps that will be followed if a student is ill or has a non-life threatening injury?
In the case of a life threatening injury the item listed below will occur.
Dial 911 and provide the following information:
Location
Call back number
Your name
Emergency problem
Name of Teacher-in-charge
Alanna Kennard
Date (year/month/day)
2016/03/27
Signature of teacher-in-charge
Date (year/month/day)
2016/03/27
Principal: Please note the proposal should be emailed to A Online Activities without support documents and in doc. format. The
system cannot upload a PDF file or support documents. No signatures are required on the proposal. The proposal must be sent to A
Online from the Principals email account, as proof this trip has been approved.
A_Single_Proposal.doc
Off-site Administrative Assistant