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(unitatea de nvmnt)

_______________________________________
(localitatea, judeul)
______________________________________________________
Telefon................................

Ctre
Inspectoratul colar al Judeului _________

1.

rugm

deplasarea/excursia/tabra

aprobai

de

studii/agrement/tematic/concurs/festival

efectuat cu un numr de ___ elevi din clasele _________, i un numr de ____ cadre didactice
nsoitoare
2.

Itinerar: _____________________________________________________________________________________
____________________________________________________________________________________________

3.

Perioada ___________________________________ Durata excursiei: _______ zile,

L Ma Mi J V S D

iniial / reprogramat pentru_________din motive


_________________________________________

____________________________________________________________________________________________

4.

Obiective vizate: ______________________________________________________________________________


____________________________________________________________________________________________
5. Programul excursiei:
Ziua
Activitate n localitatea
Orel
Activitate n localitatea
Orele
e
Plecarea din localitatea

Sosirea napoi n localitatea


6.

Mijloace de transport: __________________________________________________________________________


asigurate de __________________________________________________________________________________

7.

Colectivul care rspunde de organizarea excursiei:


- cadre didactice nsoitoare care rspund de securitatea elevilor: Subsemnaii, nsoitori ai
elevilor n aceast excursie, declarm pe propria rspundere c vom asigura securitatea i integritatea
elevilor participani. Am efectuat instruirea elevilor, prezentndu-le normele de comportament civilizat i
cele pentru asigurarea integritii lor fizice:
Semntura
1. _________________________________________________ (conductor) __________________________
2. ______________________________________________________________________________________
3. ______________________________________________________________________________________
4. ______________________________________________________________________________________
8.

Ali aduli nsoitori (prini, rude, etc.)


1. ______________________________________________________________________________________
2. ______________________________________________________________________________________
3. ______________________________________________________________________________________

9.

Instructajul elevilor privind securitatea deplasrii s-a fcut la data de _________ i se va repeta nainte
de
plecare
de
ctre
_____________________________________________________________________________________

10. Alte meniuni cu privire la organizarea i desfurarea excursiei:


costurile excursiei sunt suportate de prini I..J. M.Ed.C. consiliul local
sponsorul
________________________________________________________________________________________
cazarea este asigurat la____________________________________________________________________
DIRECTOR,
__________________________
L.S.

Anexa 2

_______________________________________
(unitatea de nvmnt)

_______________________________________
(localitatea, judeul)

TABEL NOMINAL
cuprinznd participanii la deplasarea/excursia/tabra de
studii/agrement/tematic/concurs/festival/_______
din perioada ___________________, pe traseul _______________________________________________
_______________________________________________________________________________________
Subsemnaii, declarm c am luat la cunotin regulile de comportare i securitate
privind deplasarea n excursiile i taberele colare i ne angajm s le respectm
ntocmai.
SEMNTURA CLAS
SEMNTURA CLAS
NR
NUMELE I
NR
NUMELE I
ELEV/PRINT
A
ELEV/PRINT
A
.
PRENUMELE
.
PRENUMELE
E
/OBS.
E
/OBS.
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L.S.

DIRECTOR,
____________________________

CONDUCTORUL EXCURSIEI:____________________________SEMNAT__
CADRE DIDACTICE NSOITOARE:________________________SEMNAT_
____________________________________________________SEMNAT__
____________________________________________________SEMNAT__