A Off-Site Activity Proposal

Single Activity

PLEASE READ AND REVIEW THE CBE OFF-SITE ACTIVITIES PROCEDURES MANUAL PRIOR TO COMPLETING THE PROPOSAL
Once the Principal has approved this off-site activity:
The Principal should e-mail a copy of the proposal (do not send support documents) to A Online @cbe.ab.ca at least
one (1) week prior to the trip.
SCHOOL: UNIVERSITY SCHOOL
PHONE:
FAX:
AREA:
PRINCIPAL: DR. WENDY FREEMAN
403-555-7480
403-5551
7489
DESTINATION (VENUE):
DEPARTURE DATE (dd-mth-yr): RETURN DATE (dd-mth-yr):
Fairview Hutterite Colony
05-Apr-16
05-Apr-16
DEPARTURE TIME: 8:45AM
RETURN TIME: 12:30PM
AREA OF STUDY (AS DEFINED IN THE PROGRAM OF STUDIES):
TYPE OF TRIP:
Health and Wellness, Social Studies, Science
GRADE 5 HUTTERITE COLONY TOUR
GRADE LEVEL (Please check all that apply):
# OF STUDENTS :
MALE:
14
ECS
1
2
3
4
5
6
28
FEMALE: 14
7
8
9
10
11
12
SP
Contact phone number of the teacher-in-charge during the field trip: 403-555-0493
Facility: Fairview Hutterite Colony
Cell No. 403-555-3818
SUPERVISION

STAFF/
VOLUNTEERS

Teacher-inCharge

(1 TIC only)

Staff:
#1

(list) of Staff
Julie Hur

Volunteers:
#2

(list)of
Volunteers
Christine
Leach

Alanna
Kennard

GENDER

WHAT
CURRICULUM
AREAS ARE
TAUGHT?

DATE
OF LAST
VISIT TO SITE:

WILL YOU BE
PRESENT FOR THE
ENTIRE TRIP? IF NOT,
SPECIFY SCHEDULE.
Yes

Female

English
Language Arts

03/25/2016

Female

Science

03/25/2016

Yes

Female

N/A

N/A

Yes

Teacher in Charge has confirmed volunteers have completed the Volunteer Clearance process.

A_Single_Proposal.doc
Off-site Administrative Assistant

LIST RELEVANT
CERTIFICATIONS
(E.G. LEVEL OF FIRST AID,
ETC.
AND EXPIRY DATE)
(APPENDIX 2 AND CHAPTER 7)

Yes

No

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Supervision
Students must be supervised at all times by CBE Staff and/or Volunteers.
1

List the training, skills, knowledge and experience related to the activities and supervision in general, that support the
choice of each supervisor. List each individual separately, including the Teacher in Charge. If specific volunteers are
not known, please provide the general criteria. E.g. knowledge of students, first aid, etc. Alanna Kennard, English
Language Arts, Knowledge of students needs academically, medically and behaviourally, Julie Hur, Science teacher,
Knowledge of students needs academically, Christine Leach, Volunteer Teacher Inglewood Bird Observatory Coordinator, First
Aid Certification and experience with running weekly field trip experiences with CBE staff.

List the specific responsibilities for each supervisor?

Alanna Kennard - Supervise students during the tour; ensure they are staying with the group; greet tour guides, pay the fees.
Julie Hur - Accompany students on bus, greet tour guides, ensure students stay with the
group.
Christine Leach- Accompany students on bus, supervise students throughout the tour to
ensure they are staying with the group.

How has such information and responsibilities been communicated? (e.g. meetings, manual, written communication)
Meeting and written electornic communication.
Will the larger group be split into smaller groups at any time during the off-site activity?
Yes
No

4
5

How will you manage/split the group?

Each group of students will be accompanied by a CBE staff/ Volunteer at all times in the
morning instrument specific clinics and in the full ensemble guest conductor clinic in the
afternoon.

Method of Transportation (chapter 4)

School-owned Van (name of employee , class of license of driver )
School-owned Bus (name of employee , class of license of driver )
Rental Van (name of company: )
Arranged by Service Provider (name of carrier: Southland Transportation Ltd.)
Charter Bus (name of company: )
No transportation provided by school
Other:
Staff driver (name of employee , class of license of driver )
Has the CBE employee completed the Driver Agreement for School Staff?
Has a Driver Abstract been provided?

Yes
Yes

No
No

Volunteer Driver (name of volunteer , class of license of driver )

Has the volunteer completed the Volunteer Driver Agreement
Has a Driver Abstract been provided?

Yes
Yes

No
No

Complete If using a Service Provider, Attending Conference or Athletics Tournament

Name:
Contact Person:
Phone Number:
Fairview Hutterite Colony
Roseanne Tschetter
403-555-1234
address:
city/town:
e-mail:
Box 1234
Crossfield, AB
roseanne@gmail.com

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1. What role does the service provider have with regards to the preparation of the off-site activity?
To ensure the buildings are ready for the tour.
2. What is the role of the service provider during the off-site activity?
To direct the tour and ensure it is age appropriate, answering student's questions, etc.

RESTRICTED ACTIVITIES
Please indicate any and all of the following activities that are planned for this Off-Site Activity. By checking the boxes
below, I am verifying that I have read the information on this Restricted activity in the Offsite Manual.
Acitivity/ies
Canoeing-Flat Water
Canoe Tripping-Flat Water
Canoeing-Moving Water
Cycling
Ice Skating
Fine and Performing Arts
Hiking

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Off-site Administrative Assistant

Kayaking-Flat Water
Kayaking-Moving Water
Kayaking in Sheltered Water
Mountain Biking
Sailing
Skiing-Cross Country

Skiing & Snowshoeing

Skiing & Snowboarding-Downhill Facility
Snowshoeing
Swimming
Urban Pathways
Wall Climbing

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CBE Educational Review of Off- Site Activities

General Learner Outcomes:
English Language Arts:
General Outcome 1: Students will listen, speak, read, write, view and represent to explore thoughts, ideas, feelings and experiences.
Complete the chart below to indicate the hazards and the risks of this trip. List all the activities including transportation that will occur during the trip. List all
Social Studies:
the risks and hazards (cause of accident) in relation to the identified activities. List the precautions that have been made to minimize the risk.
General Outcome 5.1: Physical Geography of Canada
Note: Common Risks and Hazards have been identified for the specific programs. This is limited based on the possibility of different activities being selected.
General Outcome 5.2: Histories and Stories of Ways of Life in Canada
Not all risks have been identified. The T-I-C and the Principal must add in additional risks for the specific activities.
General Outcome 5.3: Canada: Shaping an Identity

Students will take part in a field trip excursion to the Fairview Hutterite Colony to see alternative lifestyles and cultures
present in Alberta. The students will be exposed to witnessing where their food comes from and the work that is involved
in gathering that food - collecitng eggs from the hens, milking cows, etc.Students will explore outcomes related to social
studies, especially when considering the histories of people who live in Canada and their lifestyles. The colony experience
will demonstrate the concept of "farm to table" when discussing where our food comes from.
Itinerary:

Specific Learner Outcomes:

(Reflect the Program of Studies, CBE 3 Year Education
Plan and/or CBE Results)

Specific Activity/Brief
Description:

Location:

The Fairview Hutterite

Colony Tour which will
include the following: a
tour through the
industrial sized cooking
kitchen; the milking cows
barn, the chicken barn,
the on-site colony school
which incorporates
grades 1-9.

Fairview Hutterite Colony

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Off-site Administrative Assistant

.English Language Arts

-1.1 Discover and Explore - Express ideas and
develop understanding
-1.2 Clarify and Extend - Consider others' ideas,
Combine ideas, Extend understanding
Social Studies
5.1.3 Analyze how people in Canada interact with
the environment by exploring and reflecting upon
the questions in the program of studies.
5.2.1 appreciate the complexity of identity in the
Canadian context
5.2.9 Examine, critically, how European immigrants
shaped ways of life in western Canada by exploring
and reflecting upon the following questions and

Method of Assessment with Brief Description:

(Self-assessment checklists, performance assessments, written
products etc. with specific student knowledge, skills and attitudes
identified. Identify use of observations and products. Attach
rubrics if used.)

The assessment of the Hutterite Colony tour will take

place back at the classroom through formative
assessment where the students will share their favourite
part about the tour. The students will have the opportunity
to share their ideas, express their thoughts and
experiences while on the tour both through verbal and
written forms of expression.

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ACTIVITY

Allergies/ Known Medical Concerns

Remoteness
Terrain

Transportation
Weather

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Off-site Administrative Assistant

Risk/Hazards (Cause of Injury)

Outdoor allergies, such as pollens, grasses, insects (including bee
stings).
The colony is located approximately 60 kilometers from Calgary
with the nearest hopsital in Didsbury.
The colony is mainly gravel, therefore students mustt take caution
when walking during the tour. Proper footwear should be worn
(closed-toe shoes) to ensure that rocks do not injure the students,
or cause a fall. The terrain on the paved pathway may be uneven
at times.
The students will ride on a Southland Transportantion Ltd. bus to
and from the camp on city and country roads. Possibility of a
vehicle accident or bus breakdown/ delay during travel.
The weather can be a factor, so students will be encouraged to
dress in layers, especially because a lot of the tour is walking
outside.

Precautions Taken
Consent and Acknowledgement of Risk Forms collected for
each student.
Allocated additional CBE staff/ Volunteers to accompany the
students on the day trip Consent and Acknowledgement of
Risk Forms collected for all Volunteers.
Met with the site supervisor and and inspected the grounds
in March to ensure the safety of the entire facility.

Booked transportation with a reputable and CBE approved

transportation company.
Students were encouraged to dress in layers and bring warm
clothing in the pre-trip meeting and in the Parent Letter.
Students are welcome to bring an umbrella in case of rain.

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Requirements Checklist
Complete and attach the following forms to the template when submitting to the Principal for approval
Consent and Acknowledgement of Risk - Student
Consent and Acknowledgement of Risk Volunteer
Parent letter
Swimming Ability Form (if applicable)
Detailed Itinerary: Provide detailed itinerary from sun up to sun down.
Teacher Summary: Use Teacher in Charge Summary form found in the Off-site document library on the website.
Attach the completed Service Request when using a Service Provider.
Trip Preparation
As the Teacher-in-Charge:
What preparation have you undertaken to gain familiarity and check the appropriateness of the site (terrain, equipment,
buses, etc.)?
On March 25 the site was visited. Indoor and outdoor programming was undertaken, as well as a full inspection of the site was
performed with the facility's site supervisor. Staff were given the full tour that the students will take.
What effects will weather have on this off-site activity?
Minimal, as the students will be outside only to move between the buildings on the tour. the instrumental clinics and guest
conductor clinic both occur indoors.
How have you prepared the students skills, and knowledge and readiness for the off-site activity?
Yes, the students have obtained pre-learning instruction, and have examined a bit of information regarding the lifestyle of
Hutterites and what to expect.
How have you ensured that parents and students have received all pertinent information regarding this trip, including
hazards and emergency procedures?
The Parent Letter and Consent and Acknowledgement of Risk Form was given to each student, electronic communication
regarding the off-site activity answering any questions or inquiries pertaining to the off-site activity occurred, and in-class direct
communication with the students took place.

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Emergency Procedures (Chapter 6) OFFSITE Activities Procedures Manual

General: Urban Environment
Identify the:
Emergency Contact phones numbers? Emergency: 403-555-3818
Non- Emergency: 403-555-0493
School Emergency Contact Info: 403-555-7480
OR

Communication devices used for emergency contact (includes cell phones, 2-Way Radios, etc)? Camp Main Phone Line & Cell Phone
Are you relying on a service provider to meet the first aid ratio? No
First Aid kit required (type): No. 2 Kit with CBE Incident Report 3 blankets
Steps that will be followed if a student is ill or has a non-life threatening injury?
In the case of a life threatening injury the item listed below will occur.
Dial 911 and provide the following information:
Location
Call back number
Your name
Emergency problem

Name of Teacher-in-charge
Alanna Kennard

I have reviewed, discussed and I APPROVE this trip.

Name of Principal
Dr. Wendy Freeman

Date (year/month/day)
2016/03/27

Signature of teacher-in-charge

Date (year/month/day)
2016/03/27

Principal: Please note the proposal should be emailed to A Online Activities without support documents and in doc. format. The
system cannot upload a PDF file or support documents. No signatures are required on the proposal. The proposal must be sent to A
Online from the Principals email account, as proof this trip has been approved.

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Off-site Administrative Assistant

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