1. EOTC Event Proposal, Approval and Intentions
Event Name:
[Redacted] Camp to Waipara Adventure Centre
Dates:
24 Oct - 27 Oct 3 nights
Person in Charge:
[Redacted]
Student group: [Redacted]
No. of
30 56
Students:
Activity outline, learning objectives and other
Assessment based
Co-curricular:
benefits:
Standards:
Swimming, high ropes, high swing, kayaking,
Health
archery, team building
PE
Confidence/Self Esteem
Literacy
Literacy - Journal Writing
Have lots of fun
Event location/venue:
Budget: nil
Waipara Adventure Centre, 137 Darnley
Student cost: 3 night camp - $330 per student - 4x
Road, RD3, Amberley
students free of charge as per hardship policy.
Prices will be less due to fundraising.
Pricing includes instructors, breakfast/lunch/dinner,
accommodation in bunks and 8 Adult helpers: $199.
Pre site visit completed: Yes/ No
Date: 2023
External Providers: Yes/No
Details: Qualified instructors provided by the centre
Accommodation:
Waipara Adventure Centre: William Smith Complex - 64
bunk bed accommodation
Transport:
School van
1. EOTC Event Proposal, Approval and Intentions form 12.02.18 Page 1 of 4
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Other vans
Parent vehicles
Emergency Communication:
Times:
Type to be used: Mobiles
Meet: 7am
Numbers: [redacted]
Depart: 7.15am
Person in charge: [redacted]
Return: 5pm
Principal: [redacted]
Provider :[redacted]
Raise Alarm time: 5.30pm
On-call Contact person:
Phone number (s): [redacted]
Name: [redacted]
Use this first page as an Intentions Form – to be left with the Office &/or On Call Person
1. EOTC Event Proposal, Approval and Intentions form 12.02.18 Page 2 of 4
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Trip Management Category (circle/highlight)
Assessment of Risk
Low
High
Overnight
Routine and expected
Where risk exposure is
Including residential and
activities and
greater than what would
overseas trips.
environments
typically be the case at
● School grounds
school
● Supervised local visits
● Adventurous activities
Significant risks identified:
Traveling to and from the centre. (Travelling over the passes to East Coast)
Swimming, kayaking, archery, high ropes.
Proposed Staffing:
Name
Responsibility or role
Qualifications/
Relief required
experience
[All redacted]
[All redacted]
Classroom teacher No. Teacher aides will
work with students that
remain at school.
Classroom teacher No
Classroom teache
r No
1. EOTC Event Proposal, Approval and Intentions form 12.02.18 Page 3 of 4
To view a copy of this license, vis
it http://creativecommons.org/licenses/by-nc/4.0/.
INITIAL APPROVAL
HOD ___________________________________
Date: ________________
EOTC Coordinator: _______________________
Date: ________________
SEE BELOW FOR ACTIONS TO NOW COMPLETE BASED ON LEVEL OF RISK
Task Checklist to complete based on Level of Risk
Low Risk
High Risk
Overnight
❑ Activity Proposal
❑ Activity Proposal
❑ Activity Proposal
❑ HOD Approval
❑ HOD Approval
❑ HOD Approval
❑ EOTC Coordinator Approval
❑ EOTC Coordinator Approval
❑ EOTC Coordinator Approval
❑ Principal/BOT Approval
❑ Staffing allocated, supervision
❑ Staffing allocated, supervision
❑ Staffing allocated, supervision
structure
structure
structure
❑ Blanket consent
❑ Parental Notification and
❑ Parental Notification and consent
consent
❑ Specific Risk disclosure
❑ Specific Risk disclosure
May include but not limited to:
May include but not limited to:
May include but not limited to:
❑ Student medical lists
❑ Student medical list
❑ Student medical list
❑ Emergency contact information ❑
❑
Emergency contact information
Emergency contact information
❑ Risk assessment
❑ Risk assessment
❑ Risk assessment
❑Emergency communication
❑ Transport plan
❑ Transport plan
plan
❑
❑
Site plan and information
Site plan and information
❑ Emergency communication plan
❑ Emergency communication plan
FINAL APPROVAL
Name
Date
Signed
Approved By
1. EOTC Event Proposal, Approval and Intentions form 12.02.18 Page 4 of 4
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it http://creativecommons.org/licenses/by-nc/4.0/.