1. 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

2. 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

3. 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

4. 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: ( ) ____-______ __________________
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: ( ) ____-______ _____________
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

5. 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

6. 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: ( ) ____-______ __________________
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 #: : $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

7. 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

8. Sacramento START SUB REQUEST FORM
STEP 3
Today’s Date: ____/____/_____
Site Director: ________________________________ Site: _____________________________________
Site Phone: ( ) ____-______ __________________
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 & 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: ____/____/_____

9. 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

10. 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

11. 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

12. 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

13. 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: (Cell) (Desk)
Joanne Marson: (Cell) (Desk)
Brian Fitzgerald: (Cell) (Desk)
START Office: (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
___________________________________________

14. 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)
Sacramento START – (916)
th 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)
Sacramento START – (916)
th 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)
Sacramento START – (916)
th Avenue – Sacramento, CA 95824
START

15. 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

16. 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

17. 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 #
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

18. 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