Fillable Quick Stepper for In-City and Out-of-City School Trips

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Quick Stepper for In-City and Out-of-City School Trips

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Quick Stepper for In-City and Out-of-City School Trips
First Day of Trips: September 30, 2019 Last Day for Trips: June 5, 2020
Please remember that every trip needs an educational purpose.
Items that need to appear on the EH-81:
1. School;
2. Learning Network
3. Principal’s signature
4. Teacher/s name;
5. Grade or Group;
6. Number of students per class (must match the class list);
7. APPROVED Site w/complete address (A list of locations is provided monthly from the
Office of Risk Management. You are not limited to these locations as long as the location
can provide an ACORD Certificate of Liability Insurance to be reviewed and approved by
the Office of Risk Management. New sites may take weeks to be approved; plan
accordingly.);
8. Date of Trip;
9. Time departing;
10. Time returning;
11. Bus Service - Yes/No;
12. This statement should appear on every EH-81: “No child will be excluded due to cost.”;
13. If there is a cost, please indicate the amount;
14. APPROVED transportation provider (These are the bus services that are contracted to
transport students.);
15. If there is cost, please indicate how it is being paid (ex., student, fundraiser, etc);
16. Please provide the names of the chaperones and identify if they are school district
personnel. If they are not, they will need to obtain the necessary clearances listed by
the Family and Community Engagement Office. These clearances are to be kept on file
at the school and the “Confirmation of Volunteer Chaperone Clearances” document is to
be submitted as part of the trip packet which requires the principal’s signature. (Names
of chaperones are typically listed under “teachers” or add an additional page).
Basic Information:
• In-City Trips: submit 2 weeks in advance; a signed EH-81/Class Trip Request Form with
all above information, a copy of the EH-80/Parent Permission Slip with the top portion
completed, a student list with ID numbers, an itinerary. These trips only require the
signature of the principal. In-city trip packets must be sent to the network office to be
reviewed for accuracy. In-city trip packets that are habitually sent to the network
office with errors and/or late, may be referred to the Chief Schools Office.
• Out-of-City Trips: submit 4 weeks in advance; a signed EH-81/Class trip Request Form
with the above information, a copy of the EH-80/Parent Permission Slip with the top
portion completed, a student list with ID numbers, an itinerary. These trips require the
signature of the Assistant Superintendent and Chief Schools Officer. Once final approval
is documented, a signed EH-81 will be forwarded to you.
• Activity Trips: trips that involve a physical activity (ex., bowling, swimming, etc), an
approved letter from Ms. Nancy Nayowith, Director for Health, Safety and Physical
Education, is required.
• Movie Trips: the name of the movie is required along with the rating. It is advised that
this information appear on the EH-80/Parent Permission Slip so that parents are made
aware while signing off.
• Trips scheduled before and after the normal school hours: please provide the name(s) of
school staff that will monitor the before and after hour drop off/pick up of students.
Please note, that NO child should be allowed to walk home upon returning from an
after-hours trip.
Please note: Even if a location is in-city, it is still REQUIRED for the
location to be approved by the Office of Risk Management.
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16
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N/A
15
No child will be excluded
due to cost.
1
2
3
STEPPER
Name of student:
THE SCHOOL DISTRICT OF PHILADELPHIA
PARENTAL PERMISSION
School School Phone Grade/Room Date Prepared
Teacher Destination
Educational Purpose of Trip
Date of Trip Trip Itinerary (summary)
Method of Transportation Cost to Student
I understand that in case of any emergency requiring medical treatment, every effort will be made to reach
one of the people listed above. If none of these people can be contacted, I authorize the school to give
consent to treatment as deemed necessary by emergency responders.
Print Name of Parent/s or Guardian/s:
Signature of Parent/s or Guardian/s: Date:
Leave Time Return Time
Student Lunch
A copy of this form is to be kept on file until the end of the school year.
BringFree Buy$_______ Provided
TRIP INFORMATION
STUDENT INFORMATION
I.D.#: Date of Birth:
PARENT/GUARDIAN INFORMATION
Student lives with (check all that applies): Father Mother Guardian
EMERGENCY CONTACTS
If the parents/guardians cannot be reached, the school will call the people listed below. The people listed
below should be responsible individuals who can: 1) give permission to administer health care; 2) pick up your
child if your child is ill; 3) have the authority to speak on behalf of the parents or legal guardians.
HEALTH INFORMATION
If permission is granted, please provide the following medical information or if your child does not have any of
the health conditions listed below, please write “none”.
Physician’s Name: Phone:
Medical/Hospital Insurance: Group: Type:
Medication/s being taken by student:
Allergies to foods, drinks, insect bites, medications, other:
Other medical information:
I have read the trip information to:
Please complete and detach the bottom part of this form and return to teacher
Name:
Home Phone:
Work Phone:
Cell Phone:
EH-80 Parental Permission (Rev. 10/06) - THE SCHOOL DISTRICT OF PHILADELPHIA
Name:
Home Phone:
Work Phone:
Cell Phone:
Check one: my child
on
may
1. Parent/Guardian: Home Address:Home Address:
Work Phone: Cell Phone:Home Phone:
2. Parent/Guardian: Home Address:Home Address:
Work Phone: Cell Phone:Home Phone:
.
may not go on this trip
Not Needed
STEPPER
CONFIRMATION OF VOLUNTEER CHAPERONE CLEARANCES
I am confirming that all required clearances as listed by the Family and Community Engagement
Office are on file at the school for the non-school district chaperones (listed below) participating
in the following trip:
School and Network
Trip Location and address
Trip Date(s)
__________________________________________________________
(Signature of Principal and Date)
Principal Name Printed: _______________________________________
TRIP CHAPERONES - FIRST AND LAST NAMES (Please print legibly)
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Quick Stepper for In-City and Out-of-City School Trips

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Completed 8 April 2022

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