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Approval Proforma for all Excursions and Activities

Requiring School Council Approval
Department of Education and Early Childhood Development
This proforma details minimum requirements for council approval. It must be submitted to the
principal for school council approval prior to the excursion.
All information on this proforma is required. Add attachments if necessary.
School councils are responsible for approving:

overnight excursions
camps
interstate/overseas visits
excursions requiring sea or air travel
excursions involving weekends or vacations
adventure activities.
Complete the Student Activity Locator online form three weeks prior to the excursion.
Sections with an * have explanatory notes included at the end of this document.
Ensure you have the most current version of this template
Download from the Safety Guidelines for Education Outdoors website at:
http://www.education.vic.gov.au/school/principals/health/Pages/outdoor.aspx

PROGRAM NAME, YEAR, LOCATION, DATE(S), TEACHER-IN-CHARGE

Name of program: Canoe Journey

Year level(s): 10
Location(s): Murray River- Tocumwal to Morgans Beach

* Date(s): Week 8, Term 2.

Name of teacher-in-charge: Miss Lina

* EDUCATIONAL PURPOSE
Having studied content within the term that promotes team work and problem solving, students will be given the
opportunity to put these skills into practice. This trip will challenge the students and provide them with the
opportunity to develop and practice the necessary skills associated with canoeing and camping. Students will
be encouraged to take leadership roles that will promote their level of independence and over confidence in
environments that they have not experienced extensively.
The journey structure of the trip will encourage students to think about the different perspectives of the river
and how it has been used over time. Students will be able to put themselves in the shoes of different stake
holders to further ingrain their knowledge of historical perspectives studied within class.
Students will integrate all components learnt prior to the trip such as navigation, identifying flora and fauna and
utilising skills such as tying knots, selecting appropriate campsites, journal writing and weather interpretation.
This journey will stimulate a range of feelings within students with the overall goal of promoting positive
relationships with the environment,

PROGRAM DETAILS
* Program outline, including:

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Supervision- Staff members will be available at all times. Rotations for rest time will implemented during the
trip as well as during travel. Students will not be permitted to go anywhere without a staff member, both on and
off the water. During canoeing, a staff member will be at the front, back and in the middle. Staff members will be
paired with students who are struggling with the paddle skills.
Day 1- The students will arrive at Tocumwal town beach late morning where they will be given an introduction of
the days events (they will be aware of this as they go over it in class). They will also listen to expectations and
participate in some quick games to get them feeling active. The staff members will refresh students on water
safety and canoe and paddle techniques. The group will then paddle to Ardley beach where they will have lunch
and then on to their first campsite (refer to map). Staff will brief students on camp boundries, toileting
procedure, taking the canoes out of the water, setting up tents and collecting firewood. Students will then cook
dinner in a group circle and follow up with a group discussion and debrief before bed.
Alternative program- If weather hinders group paddling to campsite, camp will be set up at the lunch spot and
students will undertake activities under the shelter of the group tarp.
Day 2- Students will pack up campsite, collect any rubbish and pack canoes. The staff will then conduct a 15
minute skill session on the water where students can practice their skills for the day ahead. During paddles,
students will participate in canoeing games such as follow the leader, races and obstacles courses. Students
will select a suitable site for lunch. After lunch, staff members will encourage a discussion on the European and
contemporary users of the river. Students will relate back to what they learnt during classes. After lunch the
group will continue paddling. During this time they will raft up as a group and have a discussion on the
Indigenous users of the river. They will also visit a scar tree. The group will then arrive at camp (see map) at
approximately 4:30 and will repeat the same process as the previous night. After dinner there will be another
group debrief.
Alternative program- If weather conditions do not allow for water activities, students will participate in a
bushwalk.
Day 3- Students will begin their day by observing and drawing flora and fauna species into their journal, using
techniques and examples studied in class. They will then pack up the camp and begin their canoeing with a
silent paddle. During this time they are encouraged to think about the aspects they have covered as well as
their personal view of the environment. Students will arrive at the pull out point (Morgans Beach, see map) and
will clean and pack up the canoes. The group will be ready to leave by 1pm.
During the 3 days, students will required to navigate and staff will constantly ask students to point out where
they are on the map.

* Overnight accommodation

Tents/camping
See map attached
Contact phone number(s):
Staff mobiles 04555333

Adventure activities
Tick the adventure activities that have been planned to occur during the program:
Abseiling
Canoeing/kayaking low
Cycling
Orienteering
Sailing
Snow activities
Water skiing

Base camping
Challenge ropes course high
Horse riding
Rafting
SCUBA diving
Surfing
Windsurfing

Bushwalking
Challenge ropes course
Indoor rock climbing
Rock climbing
Snorkelling
Swimming
Other:

The conduct of each activity will comply with the requirements outlined in the Safety Guidelines for that activity.
Staff providing instruction activities have read the relevant safety guidelines

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YES

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A risk management plan for the excursion must be completed and attached with this
submission. Guidance on the risk management process is available in the section of the website
called Planning Managing Risk.

* Transport arrangements
Internal

External

Both

Type of transports and seating capacity: School owned 22 seater bus

Will a member of the supervising staff be driving students?
If yes, list driver(s). Miss Lina

Yes

No

Approximate distance between school and destination: 102kms

All transport requirements comply with the advice in the School Policy and Advisory Guide,
Transporting Students and VicRoads regulations.
YES

Budget
EXPENDITURE
INCOME
$180

Transport

$200

$600

$780

Food
Accommodation
Staffing
Equipment
Other expenditure:

$0
$0
$2000
$1000

Total expenditure

$3200

Student Fees
Other income:

Total income:

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STUDENTS AND STAFF

Students
Number of female students: 9
Number of male students: 9
This trip will be discussed in the classroom; this covers navigation, safety food, gear, equipment and minimal
impact strategies. Students will be required to submit an assessment that demonstrates their level of
knowledge as well as preparedness for the trip. If students fail this assessment, they will not be permitted to
attend the trip.

* Supervising staff
Where possible all staff members including teachers, school support staff, parents, volunteers and external
contractors should be listed. Indicate those who have a current first aid qualification. Indicate staff members
with first aid and CPR training including the qualification or certification held.
Megan Quirke Level 2 First Aid
Jas Lina Remote first Aid
Emily Bartholomew Wilderness first aid and CRP

DOCUMENTATION TO BE LODGED PRIOR TO DEPARTURE

Copies of the following completed documents will be lodged with the principal or nominee and the designated
school contact, before the program commences.
Signed informed consent from parents/guardians
Completed medical form for all students and staff
Detailed itinerary with specific locations and contact numbers
A copy of map(s), including map name, access routes and grid references if required
Staff and student equipment and clothing lists
Group equipment list(s) if necessary
A supervision plan that outlines staffing allocations for activities and for non-programmed periods.
This may form part of the detailed itinerary. It must maintain at least the minimum prescribed staffing for
adventure activities.
Completed staffing details proforma
Risk management plan
Emergency response plan, including contacts for police, ambulance, doctor, hospital, fire brigade, 24-hour
school emergency contact number. This is to be held by staff on the excursion and by the nominated
school contact person
Other school-specific information:
Acknowledgement by the teacher-in-charge that all required documentation indicated on this form will be completed
prior to the program starting.
Teacher-in-charge:
Name

Jasmine Lina Signed

Date

Acknowledgement of receipt of approval proforma for activities requiring school council approval.
Principal:
Name

Signed

Approved and minuted at a school council meeting on _______

Date
_______

_________

School Council President:

Name

State of Victoria (DEECD) 2013

Signed

October 2013

Date

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State of Victoria (DEECD) 2013

October 2013