WHSA%20Overnight.pdf

Parent document: Regular Board Meeting, 5_00 pm-03-07-2024.pdf

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Today’s Date: 2/13/2024

BREMERTON SCHOOL DISTRICT
FIELD TRIPS AND EXCURSIONS REQUEST FORM

NAME OF SCHOOL: West Hills STEM Academy
NAME OF TEACHER(S): Allyson Smith and Stephanie Doornink

DATE(S) OF TRIP: 03/25-03/27
TIME LEAVING SCHOOL:930AM TIME OF RETURN TO SCHOOL: 130PM
DESTINATION: Nature Bridge

PURPOSE: (clearly define, add relationship to Essential Learnings)
Teambuilding, ties to 5th grade essential science standards, adding life experiences that that migh
not have had before.

PARTICIPANTS: (class/grade, group. specify who and how many)

Mrs. Smith's 5th Grade: 23 students. —
Miss Doornink's 5th Grade 23 students

ADULT SUPERVISORS*: (List adult supervisors, staff, and/or volunteers)

*All adult supervisors, staff, and/or volunteers must adhere to Bremerton School District policies

during the entire trip/excursion.

Tom Hornburg, Mavis Hamrick, Carol Hardebeck, McKenzie Roark, Austin Adams, Allyson Smith,
Stephanie Doornink

POTENTIAL RISK OR DANGER: (Example: Water, mountains, woods, etc.)
Identify risk factors surrounding this excursion.

- Woods

- Water

- Allergies

SAFETY ASSURANCE: Describe strategies and plans for safety assurance of the above-
mentioned potential risks or dangers.

Teaoher supervision

Grouping Students

STUDENT COST FOR THE TRIP: NA

SUBSTITUTE NEEDED? If so, for whom and for which people?
Mavis Hamrick, Austin Adams, Tom Hornburg, Carol Hardebeck


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ARRANGEMENTS: The recommended mode of transportation for field trips should be the
school district vehicles or vehicles belonging to a commercial carrier contracted by the district.
If a private vehicle is used for transportation on a field trip, the owner of said vehicle must sign a
transportation Letter of Awareness form. Field trip arrangements will be made at the building
level by the building administrator. A request for transportation must be sent to the
transportation supervisor two weeks prior to out-of-town trips and one (1) week prior to in-town
trips.

Mode of Transportation Bus

Transportation request sent to Marco DiCicco 10/3/2023
(Name) (Date)

OUT OF STATE AND OVERNIGHT TRIPS: Out of state and overnight field trips must also
include the itinerary, housing plans and District/student costs and how trip is being funded.
Board approval is required. Requests should be sent to the Superintendent at least two (2) weeks
prior to the Board meeting before departure. (Board approval required before funds are solicited
for any trip/excursion).

Lodging: [ | Hotel Name:

Private Homes

other: Nature Bridge Outdoor ScIneo|

How is trip funded? [asp Account [| Field trip account

[_]co- curricular [X] Federal grant

PARENT APPROVAL: Participating students must have written parental permission for each
field trip and be under the direction of a certificated or professional District employee.

Permission slip sent to parent(s)
January/February/March 2024Electronic or
Paper

(Date)

BUILDING ADMINISTRATOR APPROVAL:

Mong: Shert

(Signature)

OARD APPROVAL: (For out of state or overnight trips,



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STUDENT TRAVEL EXPENDITURES AND REVENUES

| Revenue Source
Expense Category Amount (list budget account if Comments/Remarks
applicable)

mee | ga | Stake Alla
airplane) ( ei mb v ( yy wo ft

Registrations/
entry fees

Hotel
Meals
en ie

Totals

Total out of pocket cost to individual student: D

Please check all that apply:

Bremerton School District
April 15, 2004