Outside Activity Proposal These forms must be filled out completely by the organizer no less than two weeks prior to the date of the desired activity. When you have filled out this forms, each submission will automatically go to the following collaborators: Eric Dustman, Andrew Hasbrouck, Maggie Meng, Front Desk. The organizer of this event will also receive a copy of their submission in their email. Please forward this email to any staff member named below as a participant, and any staff member whose regularly-scheduled students would participate in this activity. Where is your proposed Field Trip?*Please chooseWithin QingdaoWithin ChinaInternationalActivity Name* Please make sure you fill in the name of your Activity everytime you fill in a form. Participating Grades* Grade 1 一年级 Grade 2 两年级 Grade 3 三年级 Grade 4 四年级 Grade 5 五年级 Grade 6 六年级 Grade 7 七年级 Grade 8 八年纪 Grade 9 九年级 Grade 10 十年级 Grade 11 十一年级 Grade 12 十二年级 Organizer*Please ChooseAbbie Qian（钱晓婉）Alice Shan (单慧）Almon YaoAlzbeta SpringerAmber Song (宋美龄）Amelie Lin (林宏伟）Amy Tian （田欣）Andrew HasbrouckAnna KudeliaApple Liu (刘欣）Brian QuistCanan CermenCecilia FloresCharla EsserChris BorodenkoChris VicariChristopher McCarthyDan NorthDevin SmithEric DustmanGinny Wang(王明艳）Guangbin Xiao (肖广斌）Hailey Chen（陈瑾）Helena ArranzHui Yuan (袁慧）Indah VibriantyJack Zhang （张海鹏）Jacqueline OussorenJessica VargasJim Zhai （翟金鑫）Jon SpringerJoseph Donald Holtrop (JD)Juan Rafael Angel MendozaJustin Sun （孙孝东）Kelly Li （李顺章）Kirsten LozaKristen Li (李笑爽）Lauren McCoy BorodenkoLee Wang (王群刚）Lily Xing （邢丽青）Liyan (李岩）Lulu Zhang (张璐）Lynn Wang （王文文）Magen Li （李小宁）Maggie Meng （孟苇）Mark BrierleyMegan MartineauMeta MooreMia Xiao （肖逢）Michelle OvermanMin Luo （罗旻）Murat GokalpNancy Wan (万真）Nancy Wang （王恩娜）Nathan AshelmanPeter KutinQin Jie （秦洁）Renee DustmanReuben FizgeraldRosanne GoedhartRosemary GosseSabrina Zhong （钟珊）Samara Du(杜冠男）Sandy Ma （马希宁）Sarina Sun (孙爱荣）Sean OussorenShannon Elizabeth CarneyShawn SkinnerStefanie Liu （刘晨）Stella Zhao(赵萌晓）Sunny Wang (王阳）Suzy Cui (崔立新）Trisha HasbrouckVivian CuiWei Song （宋玮）Weiguo Sun （孙卫国）Xiangzhong Kong （孔祥忠）Yanling Fu （傅延玲）Yingzhan Li (李迎战）Yu Gao （高煜）Yufen Dong （董玉芬）Organizer Email* (The organiser will receive a copy from each form submission on this email)1. Basic InformationDate of Fieldtrip MM slash DD slash YYYY From what time to what time? Participating Teachers/StaffEstimated number of students Direct Activity Costs (admission, non-QAIS transportation, equipment rentals, etc)Costs to be borne by each student Additional Requirements or Restrictions2. Educational PlanPlease fill in the following details about your planned activity. You are welcome to include references to the Learner Profile; however, please be sure to include details as appropriate. What is your vision for this activity?What is the educational objective for your students?How does this activity connect with your current unit?What learning activities will the students engage in?Will student participation be assessed? If so, how?3. Risk AssessmentBefore submitting this form, QAIS requires that the organizer and one other staff member visit the proposed location and fill out the Generic Risk Assessment document (separate document). Please identify the individual responsible for each of the standards below: 1.Planning the route to ensure safe travel and disembarkation wide walk ways; availability of toilets; and contingency plan if there are any changes or complications on the event day. First Name Last Name 1.Email*A copy will be sent to the responsible person's email. 2. Carrying a reliable mobile phone with charged battery and adequate prepaid balance, in order to serve as the point of contact for school and parents. First Name Last Name 2. Email*A copy will be sent to the responsible person's email. 3. Ensuring that students are aware of learning objectives, logistics/schedules, behavior expectations, and emergency procedures. First Name Last Name 3. Email*A copy will be sent to the responsible person's email. 4. Preparing and administering First Aid in the event of an injury.Please pick up a QAIS first aid kit from the Nurse's Office First Name Last Name 4. Email* Travel Logistics 1Direct Activity costs. Itemized for: Transportation Method Plane Train Bus Boat Other 1. Travel Expenses (Identify Plane or Train) 2. Insurance 3. Any Admissions Fees 4. Non-QAIS Transportation 5. QAIS Transportation 6. Equipment rentals 7. Food 8. Accommodations Total ¥ 0 Cost to be borne by1. School 2. Students How will fees be collected for student borne costs?Additional Details, Requirements, Restrictions, Details:1. Transporation2. Accommodations3. Food4. Others (List Each) Forms . Staff Forms |
