Documente Academic
Documente Profesional
Documente Cultură
Updated: 04/12
NAME OF EXCURSION:
DESTINATION:
Wilmington
NATURE OF EXCURSION
(a)
Provide an outline of the excursion, including places to be visited and a program of proposed activities. (Attach further sheets if required.)
Bus to Wilmington, eat Recess, visit the Wilmington old Toy museum and the puppet museum, Eat lunch, and return on the bus.
(b) Curriculum Links/Outcomes
History : How the stories of families and the past can be communicated, for example through photographs, artefacts, books, oral histories, digital media, and
museums (ACHHK004) Explore a range of sources about the past (ACHHS018) Identify and compare features of objects from the past and present
(ACHHS019) Differences and similarities between students' daily lives and life during their parents and grandparents childhoods, including family traditions,
leisure time and communications. (ACHHK030) Drama :Present drama that communicates ideas, including stories from their community, to an audience
(ACADRM029) Respond to drama and consider where and why people make drama, starting with Australian drama including drama of Aboriginal and Torres
Strait Islander Peoples (ACADRR030) Explore role and dramatic action in dramatic play, improvisation and process drama (ACADRM027) Design and Tech:
Identify how people design and produce familiar products, services and environments and consider sustainability to meet personal and local community needs
(ACTDEK001) Explore how technologies use forces to create movement in products (ACTDEK002)
(c)
Dates (Inclusive)
From:
or
to:
predominantly educational, GST must be added to the food charge, but all other
charges to students are GST-free
$5.90
GST)
22
09
15
Charge to student
Year
Level
Male
Female
Total
11
on:
$6.50
Entrance Fee(s)
($30, $25)
$2
$4.12
$12.60
Accommodation
$12
$5
19
TEACHERS AND OTHER LEADERS QUALIFICATIONS AND RELEVANT EXPERIENCE (ATTACH FURTHER SHEETS IF NECESSARY)
Teacher in Charge
TN
SSO
Police Check
SN
ACEO
Police Check
AM
Leadership/AET
Police Check
LM
Grandparent
Police Check
Name(s)
VC
EMERGENCY ACTION
Detail the plan for emergency action should the need arise. All teachers and leaders involved in the program should have this information.
(Attach further sheets if required.)
We will have an allocated fire emergency meet point outside the Toy museum/puppet museum.
We have all the students carers phone numbers
All adults will have a mobile phone.
Sage will be our First Aid officers and we will have a first aid kit with us. We will have all students necessary medication/puffers with us.
We have all the emergency phone numbers for the nearest hospital, doctors, police and ambulance.
TRAVEL ARRANGEMENTS
(a)
Intrastate/Interstate Travel
Mode of travel to be used
Bus
Departure time
3 0 am
3 0 pm
Phone No
Private vehicle/name of owner/ registration number (Insurance category: Third party property or comprehensive)
Name of Owner
Registration No
Insurance Category
(b)
Overseas Travel provide a detailed itinerary of all travel arrangements for excursion. Attach separate sheets including overseas travel
proposals (FORM NP11) completed by each departmental employee.
(c)
Charter air travel indicate why charter air travel is required. (Attach further sheets if required.)
Signature
Teacher-in-charge
Date //
APPROVALS
PRINCIPAL/DIRECTOR APPROVAL FOR CAMP/EXCURSION
Based on the stated curriculum links/outcomes, I certify that this camp/excursion is predominantly educational
Signature
Principal/Director
Yes
Date //
Regional Director
Date //
No
ED170
Updated: 05/12
As a parent/guardian of:
STUDENT/CHILDS NAME
I:
PARENT/GUARDIAN NAME
Travelling to Wilmington by PASS bus, to visit the Wilmington Toy Museum and the Puppet Museum. Links to History,
Drama and Design and Technology.
at/on:
LOCATION
OR ON:
The school/preschool will use the students current Health Care Plan unless otherwise instructed.
Has a current Health Care Plan been provided to the school/preschool?
Yes
No
If No, please provide an updated Health Care Plan to the school/preschool on completion of this form.
.
Agreement
I agree to delegate my authority to supervising teachers/instructors. Such supervisors may take whatever disciplinary
action they deem necessary to ensure the safety, well-being and successful conduct of the students as a group and
individually.
In the event of an accident or illness and contact with me being impracticable or impossible, I authorise the teacher-incharge to arrange whatever medical or surgical treatment a registered medical practitioner considers necessary. I will pay
all medical and dental expenses incurred on behalf of my child.
I have also attached additional or updated health care information, including details of any additional health support
he/she requires to undertake the above activities safely. I also consent to my childs doctor or medical specialist being
contacted in an emergency.
The information given is accurate to the best of my knowledge.
Signed:
Date:
ADDRESS
POSTCODE
HOME TELEPHONE
WORK TELEPHONE
ALTERNATIVE TELEPHONE
*Any health care information provided is not intended to prevent your child participating unless specific medical advice warrants exclusion. The health care
information you supply to the school/preschool will be treated confidentially. Such information is sought in order to protect and assist the student so the
activity may be a safe and enjoyable experience. Please contact the teacher-in-charge if you wish to discuss any health care problems.
The DECD CAMPS & EXCURSIONS GUIDELINES FOR SCHOOLS & PRESCHOOLS is available at:
http://www.decd.sa.gov.au/docs/documents/1/CampsandExcursionsGuide.pdf
Medical andPhnConsent
Form
86425866
Fax
Date of Birth..
Contact No.
Seizures, epilepsy
Diabetes
Heart Disorder
Hearing Impairment
Skin Condition
Swallowing/Choking
Communication difficulties
Have you attached health care details from your childs doctor/treating health
professional? YES/NO
If NO, staff will provide standard supervision for safety and first aid.
If YES, please write down what you have attached and please ensure all relevant
medication is provided
CONFIDENTIAL
To be completed by the Parent/Guardian for students to participate in the excursion to attend the Room 19
Section 3: Consent
I give my consent for my child named above to participate in the Room 19 Wilmington History
Excursion on the 22nd of September 2015.
I understand that school staff will be present and provide supervision for safety.
Parent/Guardian.
Date.
Thank you,
Sage Othams
Room 19 Class teacher
AN
Principal