LHS%2C%20Key%20Club%2C%20March%2028-30%2C%202025.pdf

Parent document: School Board Regular Business Meeting-01-28-2025.pdf

Text

Docusign Envelope ID: 1DBAC6B0-B9E9-4CC4-B1CF-01COCBCE4D44

AD P-101
~ =v Edmonds Request for Field Trip, Excursion,
== School District oF Outeieor Education

This form is being submitted pursuant to Policies 2320 Field Trips, Excursions and Outdoor Education and related
procedures; 6622 Student Transportation and related procedures.

Instructions
Originator:
¢* Completes form, via DocuSign
¢ Submits to principal for review

Initial
Principal: | IS
¢ Reviews form for compliance to policies and procedures 2320 and 6622

« Signs at bottom

When complete, principal sends to administrative assistant for elementary (mcgiek280@edmonds.wednet.edu) or secondary
(anderson|i@edmonds.wednet.edu) education three weeks prior (No Exceptions) to the next scheduled board meeting.

Name of school/program: Lynnwood High School/Key Club
Group: Key Club Destination: Seattle Convention Center/Sheraton Grand
Date(s) of trip: March 28 to March 30 Number of students: 24

Number of chaperones:
(min. of 2 chaperones, but must meet 1 per 10 ratio beyond that)

Grade level(s): 10-12 What is the cost per student: 240.00
List all funding sources for trip, including available scholarships: Is this event CTE funded:
Key Club Funds, Lynnwood Kiwanis donated funds, student families LyYes KJNo

Objective, curriculum and learning activities:

The Key Club District Convention is a district wide convention for young club/community leaders who want
to serve their communities through the development of service projects both locally as well as world
wide. Student attend workshops, listen to guest speakers, network with other clubs from around the
Pacific Northwest as well as elect their new district board members, and of course, have fun.

Transportation (select all that apply):

[_} District bus [J Van

_] Private vehicle, # of drivers - all drivers must be certified through procedures as outlined in 6622)

_j Watercraft transportation: Other than Washington State Ferry watercraft, compliance with Washington Schools Risk
Management Pool (WSRMP) requirements exist. Please contact Risk Management at riskmanagement@edmonds.wednet.edu
[X] Other (describe): Families provide own transportation for their student to/from Convention Center

Name of staff member or adult chaperone who has current first aid and CPR card:
James (Michael) Caesar

Overnight accommodations:
Sheraton Grand Hotel

Are there any other organizations, sponsors, or co-sponsors involved with this field trip (e.g. travel agencies, sports
organizations, etc.) contractually or otherwise? [JNO [XJ YES
If YES, please provide the name(s) of the organization(s) and details of involvement:

Kiwanis/Key Club International

Signatures below indicate Originator and Principal or Designee have reviewed all related policies and procedures while
pl ingshis field trip, and that principal or their designee approves this trip:

127972024

Signature of Originator a
12/9/2024

Signature of Principal Date

or Designee

DS
| UA Rev 9/23