Sacramento START Field Trip 8-Week Checklist PG. 1 OF 3 School: ________________________________________________________________________________ Date of Trip:__________________________________________________________________________ Trip Destination: ________________________________________________________________________ Site Director: ___________________________________________________________________________  The following list will assist the site director through the field trip process. Please see the Site Ops Supervisor for specific information regarding each item. DATE COMPLETED STEP 1: INITIAL PLANNING 8 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS NEEDED: FIELD TRIP DIRECTORY & PRELIMINARY FIELD TRIP PROPOSAL  Use the FIELD TRIP DIRECTORY to complete a PRELIMINARY FIELD TRIP PROPOSAL FORM for STEP 1 Develop a description of all activities; include transportation and eating plans; list unusual aspects of the trip; include all related brochures Estimate the planned number and ages of participating students and chaperones needed (Standard: 1 to 10 ratio; aquatics: 1 to 8 ratio) Determine proposed costs and funding Determine and document the educational benefit of the field trip Identify if the field trip has special hazards, including on/in/near water, in remote locations/hiking, involving animals, and/or outdoor education; avoid high-risk activities Review field trip plan with principal Submit to Site Operations for approval STEP 2: PENDING APPROVAL 7 WEEKS BEFORE TRIP DATE DUE: ____/____/_____   Receive an approved PRELIMINARY FIELD TRIP PROPOSAL from Site Operations DATE COMPLETED STEP 3: DETAILED PLANNING 6 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS NEEDED: FIELD TRIP ITINERARY, EMERGENCY PROCEDURE, SUB REQUEST FORM & PARENT FIELD TRIP PACKET  Develop a detailed FIELD TRIP ITINERARY for STEP 1 Contact place being visited to make preliminary arrangements Evaluate the field trip site for potentials hazards, special requirements of location and activity, and accommodations Develop an EMERGENCY PROCEDURE for missing students, injury, accident, or impropriate activity; submit to Site Ops Supervisor Responsibility of Program Supervisor: Review all contracts and insurance requirements (the Program Supervisor reviews and signs any contracts and all forms) Arrange for transportations If school bus, submit request for transportation If other, check with Site Operations for guidelines Arrange for food services (if needed) Identify risks associated with this field trip; discuss with the staff

Sacramento START Field Trip 8-Week Checklist DATE COMPLETED PG. 2 OF 3 Sacramento START Field Trip 8-Week Checklist DATE COMPLETED STEP 3: DETAILED PLANNING 6 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS NEEDED: FIELD TRIP ITINERARY, EMERGENCY PROCEDURE, SUB REQUEST FORM & PARENT FIELD TRIP PACKET  Determine STAFF and Volunteers (PROCESSED & CLEARED) needed: 1-Day Volunteers are not allowed Ensure adequate number based on the type of activities planned and the age of the students for developmental appropriateness; ratio approved by Site Ops Supervisor Ensure STAFF qualified for special needs (first aid trained, lifeguard, etc.) Ensure they received Program Volunteer Guidelines Inform Site Ops Coach of Field Trip Provide copy of CLEARED VOLUNTEER APPLICATION to Site Ops Supervisor Arrange for needed equipment and supplies, including emergency equipment Assemble PARENT FIELD TRIP PACKET and submit for approval to Site Ops Supervisor, include : Completed Field Trip Permission Slip Completed Field Trip Reminder Notice Completed ICE Cards If a substitute is required, submit a SUB REQUEST FORM to the Site Ops Supervisor   Arrange for supervision of students who opt out of the field trip STEP 4: PENDING APPROVAL 4 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ Receive final Site Operations Administrative approval for PARENT FIELD TRIP PACKET, SUB REQUEST FORM, VOLUNTEER CLEARANCE, ITINERARY, & EMERGENCY PROCEDURE DATE COMPLETED STEP 5: FINAL PREPARATIONS 3 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ FORMS: PERMISSION SLIPS, ON-SITE LESSON PLAN, SUB REQUEST FORM  Provide PERMISSION SLIP to Parents/Guardians Provide to Site Ops Supervisor a complete ON-SITE LESSON PLAN for students who opt out of field trip Confirm transportation with Site Ops Program Supervisor Confirm food services with Food Services Manager (if needed) Confirm availability of needed equipment and supplies STEP 6: FINAL PREPARATIONS II 2 WEEKS BEFORE TRIP DATE DUE: ____/____/_____ Approval needed from Site Ops Program Supervisor: Meet with school nurse to plan medication needs/dispensing for students; arrange for distribution of special medication on the field trip (trained staff and secured medications) Provide orientation for volunteers and substitutes; ensure adequate supervision will be available Confirm food storage with venue and Food Services Manager (if needed) Confirm arrangements with place(s) to be visited (if needed) Confirm arrangements for special medications with Site Ops Program Supervisor Confirm SUB REQUEST with Site Ops Supervisor Complete 24-HOUR CONTACT LIST

Sacramento START Field Trip 8-Week Checklist DATE COMPLETED PG. 3 OF 3 DATE COMPLETED STEP 6: FINAL PREPARATIONS II 2 WEEKS BEFORE TRIP DATE DUE: ____/____/_____   Ensure parental permission is obtained and emergency information is available; Every student has returned a completed FIELD TRIP PERMISSION SLIPS Provide the school office with a copy of the signed FIELD TRIP PERMISSION SLIPS (original of these forms stay with the site director) A copy of the parent permission/emergency medical form for each student and staff member are placed in a binder for SD’s use  Review completed PERMISSION SLIPS and create MASTER STUDENT ROSTERS & TRACKING FORM Review EMERGENCY PROCEDURE for missing students, injury, accident, or impropriate activity with staff Check emergency supplies and essential items for the trip DATE COMPLETED STEP 7: ASSESSMENT 1 WEEK BEFORE TRIP DATE DUE: ____/____/_____ FORMS: PERMISSION SLIPS, REMINDER NOTICE, STUDENT ROSTERS, STAFF EMERGENCY CARDS, & 24-HOUR PHONE NUMBER LIST  Confirm there is adequate adult supervision for the trip; check the number of students to staff ratio Ensure adequate transportation On Monday, provide parents/guardians with FIELD TRIP REMINDER NOTICE Provide principal with a FIELD TRIP REMINDER NOTICE Practice EMERGENCY PROCEDURE for missing students, injury, & accident with staff Completed STAFF FIELD TRIP EMERGENCY CARD for participating STAFF Make sure the staff/chaperones on the field trip have a 24-HOUR PHONE NUMBER LIST for administrators, and school office/administrator has (cell) phone number of staff on the trip DATE COMPLETED STEP 8: FINAL CHECK DAY OF TRIP DATE DUE: ____/____/_____ FORMS: ROSTERS, ICE CARDS, PERMISSION SLIPS, STAFF EMERGENCY CARDS , 24-HOUR PHONE NUMBER LIST  Confirm there is adequate field trip student to staff ratio If special equipment or clothing is needed for each student, ensure that it is provided Get medication for students from the office and ensure medications are secured Remind principal of field trip Provide STAFF with finalized STUDENT TRACKING ROSTER FORM Review behavior and safety standards with students and chaperones before departure, including: Reinforce school rules and expectations The system of accounting for students and the use of the BUDDY SYSTEM & ICE CARDS Review emergency procedures (for injury, accident, or inappropriate activity) Explain what to do if a student gets separated or lost from group Review with bus driver drop off and pick up arrangements; share contact number with bus driver DATE COMPLETED STEP 9: FIELD TRIP DEBRIEF 1 DAY AFTER TRIP DATE DUE: ____/____/_____ FORMS: DEBRIEF NOTES, 8-WEEK CHECKLIST   After the field trip, evaluate field trip procedures and the activities involved to ensure field trips in the future are safe; Submit DEBRIEF NOTES to Site Ops Supervisor  Submit completed 8-WEEK CHECKLIST to Site Ops Supervisor

Preliminary Field Trip Proposal (1 of 2) Sacramento START Preliminary Field Trip Proposal (1 of 2) STEP 1 Use the Field Trip Directory to assist with finding a destination Preliminary Field Trip Proposal & Field Trip Itinerary MUST be submitted two months prior to the event date All Field Trips must celebrate the Mission & Vision of Sacramento START Late and/or incomplete Field Trip Proposals & Preliminary Field Trip Itinerary will not receive approval All START field trips must be pre-approved by the Site Ops Team and principal prior to any arrangements and announcements to START participants SITE CONTACT INFORMATION Today’s date: ____/____/____ Site: ___________________________________________________________________ Site Director: _________________________________ Site Phone: ( ) ____-______ Email: __________________ FIELD TRIP INFORMATION Field Trip Destination: ________________________________________________________________________________ Address: ____________________________________________ City:_________________ C.A. Zip: _________________ Date of Trip: ____/____/_____ Departure Time: ____:____ p.m. Return Time: ____:____ p.m. Educational Benefit of the Trip: _______________________________________________________________________ ______________________________________________________________________________________________________ INFORMATIONAL CONTACT Have you made an initial phone call to the field trip destination? Yes No Contact Person’s Name: __________________________Phone Number: ( ) ____-______ Email:_____________ ADMISSION Estimated # of Students Attending: ____ Grade Level ____ Adults Attending: ____ Cost per Child $____ Cost per Adult $____ Discounts/Group Rate: Yes No Discount $____ Total Proposed Cost Of Field Trip Admission: $_______________ SUPPER/SNACK Can students consume food on field trip grounds? Yes No If no, where will students consume supper/snack? On Campus Off Campus STUDENT “WHAT TO BRING” LIST: STUDENT “WHAT NOT TO BRING” LIST:  TRAVEL Means of Travel: Bus Walking Public Transportation Other:____________________________ Field Trip Distance: ____Miles Length of Drive: ____Hours ____Minutes START 2013-14

Preliminary Field Trip Proposal (2 of 2) Sacramento START Preliminary Field Trip Proposal (2 of 2) STEP 1 ON-SITE (STAFF NOT PARTICIPATING ON FIELD TRIP) Staff Names (Non-Participants): ______________________________________________________________________ Substitute Needed: Yes No  FUNDING How do you plan to fund this field trip?_______________________________________________________________ ______________________________________________________________________________________________________ District support provided: Yes No Explain: ____________________________________________________  VISION & MISSION Describe how this field trip fits into the Vision & Mission of the Sacramento START Program: ______________________________________________________________________________________________________ Materials/Resources Needed: ________________________________________________________________________ APPROVAL Reviewed PRELIMINARY FIELD TRIP PROPOSAL with Principal on: ____/____/____ Principal’s request: __________________________________________________________________________________ Principal’s Signature: _________________________________________________ Date Approved: ____/____/____  TIME CONFLICT Is there a conflict with School’s Release Time: Yes No Early release approval needed at: ____:____ p.m. Approval from Principal: Yes No (Principal’s Initials:______) Related Brochures/Information Attached?  Yes  No Does The Trip Involve Any Of The Following: In/Around Water  Outdoors  Animals OFFICE USE ONLY _____ APPROVED Proceed by submitting a FIELD TRIP ITINERARY _____ DENIED See comments below regarding Policy & Procedure _____ REQUEST IN PROGRESS Schedule an appointment for more information Comments:___________________________________________________________________________________________ ______________________________________________________________________________________________________ Program Supervisor: ____________________________________________________________ Date: ____/____/____ Total Proposed Cost of Field Trip Admission: $_______________ Total Proposed Cost of Field Trip Travel: $_______________ Total Proposed of Field Trip (Admission & Travel): $_______________ Superintendent’s Signature: ____________________________Date: ____/____/____ APPROVED DENIED Budget approved by superintendent: Yes No START 2013-14

Field Trip Itinerary (1 of 2) Sacramento START Field Trip Itinerary (1 of 2) STEP 3 SITE CONTACT INFORMATION Today’s date: ____/____/____ Site: _________________________________________________________ Site Director: ________________________ Site Phone: ( ) ____-______ Email: __________________ FIELD TRIP INFORMATION Field Trip Destination: ______________________________________________________________________ Address: ____________________________________ City:_________________, C.A. Zip: _______________ Date of Trip: ____/____/_____ Departure Time: ____:____ p.m. Return Time: ____:____ p.m.  TIME CONFLICT Is there a conflict with School’s Release Time: Yes No Early release approval needed at: ____:____ p.m. TRANSPORTATION: Means of Travel: Bus Walking Public Transportation Other:____________________________ # of Adults Riding the Bus: ____ # of Students Riding the Bus: ____ Total # of Participants Riding the Bus: ______ Total Proposed Cost Of Field Trip Admission: $____  STUDENT TO STAFF RATIO Standard; 1 to 10  aquatics; 1 to 8  Number of Staff/Volunteers needed:_____ Field Trip Staff Names: ______________________________________________________________________ Processed and Cleared Volunteers Names: ___________________________________________________ Copy of Volunteer Clearance Attached: Yes No SUPPER/SNACK Can students consume food on field trip grounds? Yes No Where will students consume supper/snack? _______________________________________________ Food Services Contacted? Yes No Person Contacted from Food Services: _______________________________________________________ Perishable Items:  Yes  No Location of Storage for Food on Trip :__________________________ Trash Bags Needed:  Yes  No Staples: Can Liners-Item #: 518102: $13.39 (50/bx.) ON-SITE (STAFF NOT PARTICIPATING ON FIELD TRIP) Staff Names (Non-Participants): _____________________________________________________________ Person In-Charge:___________________________________________________________________________ Substitute Needed: Yes No Attached a Sub Request Form: Yes No START 2013-14

Field Trip Itinerary (2 of 2) Sacramento START Field Trip Itinerary (2 of 2) STEP 3  HAZARD ASSESSMENT: Potential Hazards: _____________________________________________________________________________________________ SUPPLIES AND EQUIPMENT FOR STAFF TO BRING: Cell Phone First Aid Kit Completed Permission Slips Updated Student Rosters Site Operations Communication Protocol 24-hour Contact List ___________________________________________ 24-HOUR CONTACT LIST: Principal’s 24-Hour Emergency Contact #: __________________________________________ District’s Area Specialist Contact #: _________________________________________________ Area Specialist Name: _______________________________________________________  ITINERARY ESTIMATED TIME ACTIVITIES : START 2013-14

Sacramento START SUB REQUEST FORM STEP 3 Today’s Date: ____/____/_____ Site Director: ________________________________ Site: _____________________________________ Site Phone: ( ) ____-______ Email: __________________ FIELD TRIP INFORMATION Field Trip Destination: ______________________________________________________________ Address: ____________________________________ City:_________________ C.A. Zip: _________ Date of Trip: ____/____/_____ Departure Time: ____:____ p.m. Return Time: ____:____ p.m. SUB REQUEST INFORMATION Number of Substitutes requesting: _____ Grade Level Needed: Primary  Intermediate  Substitute Field Trip Orientation (2-Weeks before trip): ____/____/_____ Time: ____:____ p.m. to ____:____ p.m. Request Steps: Request – complete the Sub Request form & submit for approval 6-weeks before field trip Site Director Request– complete request section for field trip & submit with payroll Program Supervisor Authorization – complete approval for Sub Request & Submit to Sub Coordinator within 1 week; provide Site Director with copy Sub Coordinator Authorization – complete approval for Sub Request & email site staff of approval or denial within 2 weeks Be Advised: All Requests must be submitted 6- weeks in advance to assign a substitute; Field Trips not within ratio will jeopardize your fieldtrip! AUTHORIZATION SITE DIRECTOR: X__________________________________________________________ Date: ____/____/_____ COMMENTS: __________________________________________________________________________________ PROGRAM SUPERVISOR: X ____________________________________________________Date: ____/____/_____ APPROVAL: _____Yes _____ No Date: ____/____/_____ SUB COORDINATOR: X ______________________________________________________Date: ____/____/_____ SUB ASSIGNED: _____Yes _____ No Date Assigned: ____/____/_____ 2013-14

Sacramento START On-Site Program Plan for Non-fieldtrip Participants STEP 5 It is essential to provide quality programming for students that are not participating in the fieldtrip. The chart below should serve as a lesson plan that breaks the program time into transitions: academics, rotation 1 and rotation 2. Site Directors need to describe the activities taking place on the field trip day and debrief with the staff in charge, so they are fully aware of their responsibilities. Academics: 1 hr Rotation 1: 45-60 min Rotation 2: Transition Homework Program Leader Curriculum: Enrichment Team Building Recreation Aide Curriculum: Nutrition Fitness PL Same activity – Modified for age group RA Same activity – Modified for age group Description Of Activities TRANSITIONS (Between components) Play energizer games, Review math facts, Recite group chants Do warm-up games, Stretches, Rhyming games SD Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ START 2012-13

Sacramento START Field Trip Permission Slip Page 1 of 2 STEP 3&5 Please return this permission slip to START Staff by: ____/____/____ Our START program will be going on a Special Field Trip soon. We will be leaving the site and traveling on this trip during program time. After you read the information below, regarding the field trip, we ask you to sign and date the consent form for you child to join us on this rewarding event. If you have any questions or concerns, contact the Sacramento START staff. FIELD TRIP PLAN Site Name: __________________________________________________________________ Field Trip Location: __________________________________________________________________ Field Trip Date/Day: __________________________________________________________________ Field Trip Site Departure: ___________________________Field Trip Site Arrival: _____________________ Purpose of Fieldtrip: __________________________________________________________________ Site Director’s Name : __________________________________ Phone #:________________________ Transportation for this activity will be provided by: Bus Walking Distance: _________ miles Students will have snack/supper  On Campus  Off Campus Food will be provided at (time): _________ by: ______________________________________________________ Students will need to bring money Yes No Purpose for Money:______________________________________ PARENT/GUARDIAN NEEDS TO COMPLETE THE INFORMATION BELOW I hereby give my permission for (Name of Student)__________________________to attend the field trip on the scheduled date and time listed above. I received a detailed itinerary of the trip Yes No I received a list of things the student should/should not bring Yes No MEDICAL/ EMERGECNY INFORMATION Student's Home Phone # _________________________Date of Birth ____/____/____ Grade: ____ Student’s Address: _________________________________________________________ Does the student have any medical or physical condition, medication information, or allergies which could interfere with the student’s safety? Yes No If yes, please describe: _____________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ PARENT/GUARDIAN EMERGENCY CONTACT INFORMATION: Parent/Guardian Name: ________________________________________________ Work Phone #: ____________________________________________________ Home Phone #: ____________________________________________________ Cell Phone #: ____________________________________________________ START 2013-14

Field Trip Permission Slip Sacramento START Field Trip Permission Slip Page 2 of 2 INFORMED CONSENT As the parent/guardian of the above named student, I have read the field trip itinerary and I understand that there are risks of physical injury associated with participation in these activities. I authorized qualified emergency medical professionals to examine and in the event of injury or serious illness, administer emergency care to the above name student. I understand every effort will be made to contact me to explain the nature of the problem prior to any involved treatment. In the event it becomes necessary for the staff-in-charge to obtain emergency care for my student, neither he/she nor the Sacramento START Program assumes financial liability for expenses incurred because of the accident, injury, illness and/or unforeseen circumstances. I understand these activities are an extension of the school education program and student conduct is to be in accordance with the school’s published rules and regulations. I assume full responsibility for the above participant’s behavior and agree to pay for all damages to property and/or persons caused by the participant mentioned above. I agree to release and discharge in advance the City of Sacramento their officers, employees and agents, from any and all liability for personal injury, death or property damage connected with my participation even though that liability may arise out of their negligence or carelessness.  Signature of parent/guardian: _____________________________________ Date: ____/____/____ Printed name of parent/guardian: ____________________________________________________ Special Instructions for my child:_____________________________________________________ _______________________________________________________________________________ In the event of an emergency (injury, illness, unforeseen incident), I wish the following person to be notified in case I cannot be contacted: Name: _______________________________ Relationship: _______________________ Phone #: _______________________________ Alternate Phone #:____________________ STUDENT PLEDGE I pledge that my conduct will, at all times, reflect credit upon myself, my parents, and my school. I understand that the school rules of conduct apply while on the trip. Signature of Student:: _________________________________________ Date: ____/____/____ START 2013-14

Field Trip Reminder Notice Sacramento START Field Trip Reminder Notice STEP 3&7 FIELD TRIP PLAN We would like to remind you about our field trip by providing this reminder notice that contains all the trip details. If you haven’t done so, please complete the field trip permission form provided by the site director and return it as soon as possible before the deadline date. Site Name: __________________________________________________________________ Field Trip Location: __________________________________________________________________ Field Trip Date/Day: __________________________________________________________________ Field Trip Site Departure: ___________________________Field Trip Site Arrival: _____________________ Purpose of Fieldtrip: __________________________________________________________________ Staff Contact Name : _________________________________ Phone #:_________________________ Transportation for this activity will be provided by: Bus Walking Public Transportation Other:____________ Field Trip Distance: _________ miles Students will have snack/supper  On Campus  Off Campus Food will be provided at (time): _________ by: ______________________________________________________ Students will need to bring money Yes No Purpose for Money:_____________________________________ LIST OF ITEMS TO BRING/ NOT TO BRING: ITINERARY ESTIMATED TIME ACTIVITIES : BRING… NOT TO BRING… START 2013-14

SUPPLIES AND EQUIPMENT FOR STAFF TO BRING Sacramento START 24-Hour Contact List Step 6 In case of an emergency, it is important to provide a complete 24-hour Contact List to participating staff and non-participating staff. In an Emergency…DIAL 911 Police (Non-Emergency): __________________________________________________________________ Fire (Non-Emergency): ____________________________________________________________________ 24-HOUR CONTACT LIST Ken McCulloch: 916.825.7166 (Cell) 916.808.5264 (Desk) Joanne Marson: 916.826.9256 (Cell) 916.808.6089 (Desk) Brian Fitzgerald: 916.835.7991 (Cell) 916.808.6197 (Desk) START Office: 916.808.6197 (Luz/Front Desk) Principal’s 24-Hour Emergency Contact #: _________________________________________ District’s Area Specialist Contact #: ________________________________________________ Area Specialist Name: _______________________________________________________ Site Ops Supporting Coach #: ______________________________________________________ Coach’s Name: ______________________________________________________________ Sacramento START SUPPLIES AND EQUIPMENT FOR STAFF TO BRING SUPPLIES AND EQUIPMENT FOR STAFF TO BRING: Cell Phone First Aid Kit Completed Permission Slips Updated Student Rosters Site Operations Communication Protocol 24-hour Contact List ___________________________________________

I.C.E. CARDS Contact (SD Name Here & Site #) INSTRUCTIONS: An ICE Card is a card each participant carries all day on the fieldtrip. If a student is in an emergency situation and needs to communicate with the field trip personnel or police, the ICE Card holds all the important information required by first responders to ensure our students needs are properly and safely met. Please complete the areas in grey font. Once the information is completed, change the font to black. On the day of the fieldtrip, provide an ICE CARD to all students attending the fieldtrip. Sacramento START Program Field Trip In Case of an Emergency Card (I.C.E. CARD) My START Program: (Insert School Name Here) My Site Phone Number: (Insert Phone Number Here) My Site Director/Leader Name: (Insert SD/Leader’s Name Here) This I.C.E Card must be carried by student at all times. I.C.E. Card (BACK SIDE) (1) IN CASE OF AN EMERGENCY: Contact (SD Name Here & Site #) (2) IN CASE OF AN EMERGENCY : Locate a uniformed START Staff Member or Police Officer (3) IN CASE OF AN EMERGENCY: Notify Ken McCulloch (916) 825-7166 Sacramento START – (916) 808-6197 5735 47th Avenue – Sacramento, CA 95824 Sacramento START Program Field Trip In Case of an Emergency Card (I.C.E. CARD) My START Program: (Insert School Name Here) My Site Phone Number: (Insert Phone Number Here) My Site Director/Leader Name: (Insert SD/Leader’s Name Here) This I.C.E Card must be carried by student at all times. I.C.E. Card (BACK SIDE) (1) IN CASE OF AN EMERGENCY: Contact (SD Name Here & Site #) (2) IN CASE OF AN EMERGENCY : Locate a uniformed START Staff Member or Police Officer (3) IN CASE OF AN EMERGENCY: Notify Ken McCulloch (916) 825-7166 Sacramento START – (916) 808-6197 5735 47th Avenue – Sacramento, CA 95824 Sacramento START Program Field Trip In Case of an Emergency Card (I.C.E. CARD) My START Program: (Insert School Name Here) My Site Phone Number: (Insert Phone Number Here) My Site Director/Leader Name: (Insert SD/Leader’s Name Here) This I.C.E Card must be carried by student at all times. I.C.E. Card (BACK SIDE) (1) IN CASE OF AN EMERGENCY: Contact (SD Name Here & Site #) (2) IN CASE OF AN EMERGENCY : Locate a uniformed START Staff Member or Police Officer (3) IN CASE OF AN EMERGENCY: Notify Ken McCulloch (916) 825-7166 Sacramento START – (916) 808-6197 5735 47th Avenue – Sacramento, CA 95824 START 2013-14

Field Trip Master Student Roster Form Sacramento START Field Trip Master Student Roster Form STEP 6 Date of Trip: ____/____/_____ Departure Time: ____:____ p.m. Return Time: ____:____ p.m. Educational Objective: ______________________________________________________________________ Location: ___________________________________________________________________________________ Program: _____________________________________ Cluster: ____________________________________ PRINT CLEARLY STUDENT NAME 1. 21. 2. 22. 3. 23. 4. 24. 5. 25. 6. 26. 7. 27. 8. 28. 9. 29. 10. 30. 11. 31. 12. 32. 13. 33. 14. 34. 15. 35. 16. 36. 17. 37. 18. 38. 19. 39. 20. 40. Approved by Site Director: ____________________________________ Date: _______________________ START 2013-14

Field Trip Student Tracking Roster Sacramento START Field Trip Student Tracking Roster STEP 6 Leaving the School Do a roll call, and make sure you have everyone's permission slip before boarding the bus. Give staff a completed Student Tracking Roster. These are the students the staff is responsible for. One staff to every group of ten kids is much safer than one staff to 20 kids. Do a roll call once everyone is on the bus at school. Make sure all your staff is on board, as well. At the Destination Give every staff a whistle. This will allow them to get the students' attention. Matching shirts are another way to keep an eye on students in your group. Bright colors make it easier to recognize a group member as you scan a crowd. Make sure all staff have a watch, and choose points where groups can periodically meet up. Heads should be counted to make sure participants haven't been lost. Leaving the Destination Set a time to meet at a location at the field trip site. Once everyone arrives, do another roll call. At this point, it is safe to line everyone up and get on the bus. Once again, do another roll call and check to see that everyone is on board. Date of Trip: ____/____/_____ Departure Time: ____:____ p.m. Return Time: ____:____ p.m. Educational Objective: __________________________________________________________________________ Location: ____________________________________________________________________________________ Staff Member’s Name : ___________________________________ Grade : ______ Number of Students: ______ NUMBER OF STUDENTS BUDDY SYSTEM Pair the students off with a buddy for an extra degree of accountability. Instruct them to stay with their buddies throughout the entire trip and to let an adult supervisor know if the buddy wanders off or gets hurt. PERMISSION SLIP ON BUS AT SCHOOL OFF BUS AT DESTINATION ON BUS AT DESTINATION OFF BUS AT SCHOOL STUDENT NAME 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. START 2013-14

Staff Field Trip Emergency Card Sacramento START Staff Field Trip Emergency Card STEP 7 NAME OF EMPLOYEE: Address: City: State: Zip: Home Phone # Cell Phone # Email Address: Birth Date: EMERGENCY CONTACTS In the event of an emergency these individuals may be contacted. Name: Relationship: Home Phone # Work Phone # Cell phone # DR. INFORMATION Physician: Phone Number: Insurance Name: Medical # Notes: SIGNATURE: DATE: START 2013-14

We’re going on a Field Trip! What do you think you’ll see? Sacramento START Field Trip Reflection for Students We’re going on a Field Trip! What do you think you’ll see? BEFORE THE TRIP AFTER THE TRIP I THINK I WILL SEE… I DID SEE… I AM LOOKING FORWARD TO… MY FAVORITE PART WAS… START 2013-14