SLH%2C%20INSTEP%2C%20June%203-5%2C%202025.pdf

Parent document: School Board Regular Business Meeting-01-28-2025.pdf

Text

Docusign Envelope ID: 775F3932-D082-409E-A8EE-45C5AD18BB49

AD P-101
~ =v Edmonds Request for Field Trip, Excursion,
== School District oF Outeieor Education

This form is being submitted pursuant to Policies 2320 Field Trips, Excursions and Outdoor Education and related
procedures; 6622 Student Transportation and related procedures.

Instructions
Originator:
¢* Completes form, via DocuSign
¢ Submits to principal for review

Initial
Principal: |
¢ Reviews form for compliance to policies and procedures 2320 and 6622
« Signs at bottom

When complete, principal sends to administrative assistant for elementary (mcgiek280@edmonds.wednet.edu) or secondary
(anderson|i@edmonds.wednet.edu) education three weeks prior (No Exceptions) to the next scheduled board meeting.

Name of school/program: Scriber Lake High School
Group: INSTEP Outdoor Education Destination: Olympic National Park
Date(s) of trip: June 3, 4, 5 2025 Number of students: 12

Number of chaperones:
(min. of 2 chaperones, but must meet 1 per 10 ratio beyond that)

Grade level(s): 11-12 What is the cost per student: 25.00

List all funding sources for trip, including available scholarships: Is this event CTE funded:
SLHS Student Outreach budget, INSTEP donations, Foundation for Edmonds School L]yYes KJNo
District

Objective, curriculum and learning activities:
Expeditionary Outdoor Learning program builds self confidence, team skills, stewardship of self and
natural environment.

Transportation (select all that apply):

[_} District bus K] Van

Y Private vehicle, 1 # of drivers - all drivers must be certified through procedures as outlined in 6622)

_j Watercraft transportation: Other than Washington State Ferry watercraft, compliance with Washington Schools Risk
Management Pool (WSRMP) requirements exist. Please contact Risk Management at riskmanagement@edmonds.wednet.edu
[_] Other (describe):

Name of staff member or adult chaperone who has current first aid and CPR card:

Melissa Boswell, Christopher Brown

Overnight accommodations:
Ozette Loop campsites - Cape Alva and Sand Point. Tents, sleeping bags, and gear provided by program.

Are there any other organizations, sponsors, or co-sponsors involved with this field trip (e.g. travel agencies, sports
organizations, etc.) contractually or otherwise? KJNO LJ YES
If YES, please provide the name(s) of the organization(s) and details of involvement:

N/A

Signatures below indicate Originator and Principal or Designee have reviewed all related policies and procedures while
planningshis field trip, and that principal or their designee approves this trip:

1/14/2025

Signature of Originator —
1/14/2025

Signature of Principal Date

or Designee

DS
| UA Rev 9/23