Newington HS Athletic Department
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Field Trip Forms




The purpose of these procedures is to assure the optimum health and safety of those students and staff participating.  The process of planning a field trip should be collaborative in nature and should include at least an administrator, teacher or team, and school nurse.


The least restrictive environment must be considered in the planning.  A planned trip cannot discriminate due to a student’s handicapping condition—meaning— if a group of students is going on a field trip a student with a health impairment or health-related condition cannot be eliminated from participation.  A risk evaluation by the school nurse must occur with “reasonable planning made” so all students may attend safely.  The school cannot require that a student’s parent attend so that a particular student can go.


I. Pre-planning

A.   Knowledge of location to be visited

1.     The intended field trip site should be visited or be familiar to the staff proposing the activity before the trip is taken.

2.     The site, travel in between, access to a phone, a way to contact the school office, health care issues (i.e., medication administration, treatments, handicap access, etc.) all must be considered in planning.


B.    Knowledge of students medical issues

1.     Any student with a medical issue either temporary: e.g., crutches, cast; or chronic: e.g., asthma, diabetes, bee sting allergies, must receive health room clearance for the trip.

2.     Staff must be aware of special medical issues such as allergies, disabilities, medications, etc. of student participants.

3.     Plans to handle medical emergencies must be considered in advance, e.g., phone contact, distance to nearest medical emergency service.

4.     Personnel who can administer medication on field trips are as follows:

(a)   Registered Nurse (RN) or authorized Licensed Practical Nurse (LPN) (if a parent volunteer that is a RN or LPN is used, there must be a written agreement with the school system with written expectations and assignment or delegation from the school nurse for any treatment or medication.  A copy of the parent’s nursing license must be on file.  If a LPN is used the school nurse must always be available (at least by telecommunication) to consult with when medication or procedures are delegated.

(b)  Trained teacher or administrator

5.     N.B. The parent of another student may not be designated to assume any responsibilities regarding medication or treatments even if there is a letter from a specific student’s parent allowing this.

6.     An Emergency Medical Technician (EMT) cannot be hired or used to assume any of the above responsibilities.  EMTs can function only under the auspices of the EMS system.


C.    Regular school day trips

1.     No additional orders are required unless the student requires different medications or additional doses of medication or treatments other than those received in school.  The trip must be planned far enough in advance to arrange for special transportation needs if necessary. 


D.   Extended day

1.     No additional orders are required unless the student requires different medications or additional doses of medication or treatments other than those received in school.  The trip must be planned far enough in advance to arrange for special transportation needs if necessary. 


E.    Overnight field trips

1.     If medication and or medical procedures are involved the school nurse must have written physician orders and written parental consent.  No medication, either prescription or over the counter, can be administered to a student without specific written doctor’s order and written parental consent.  A written care plan must accompany the student.  When at all possible it is advisable to obtain written permission from the physician and parent for the student to self-administer the medication.  The medication will be under the control of a trained teacher or administrator, but the student will be responsible for administering it themselves.  In the event a student cannot self administer a teacher or administrator who has been trained to administer medications must do so.


F.    Special Considerations

1.     Depending on the age of the student and appropriateness of the situation, students requiring asthma inhalers and Epi-pens will be encouraged to carry their own medication during the trip providing self administration orders are in place.

2.     The school nurse will work closely with the student, parent and primary care provider (PCP) to develop an appropriate plan for any situation where special health care needs are a concern.

3.     Parents of stable diabetic students who have glucagon orders for school, which have not been needed at all or for an extended period of time, will be asked to contact their child’s PCP or endocrinologist for an order to suspend this order for the field trip.  High school students in particular are not continually with an adult chaperone.  A student with a glucagon order would be required to remain in the constant company of the adult designated to administer this emergency medication.  The school nurse will work with the student, the parent and the PCP or endocrinologist to develop a plan appropriate for this student’s optimal health and safety.

G.   Planning

1.     Planning must be done far enough in advance to secure handicapped transportation or provide for special health care needs if needed for a particular student.  Special needs students cannot be isolated on separate transportation.

2.     Emergency/information forms (6153 (2)  shall be given to students early enough to be filled out and returned as indicated in these procedures.

H.   Procedures


1.     Students shall return permission/information slips signed by a parent or guardian at least two (2) weeks prior to the trip for one day trips extending beyond the normal school day and at least one (1) month prior for overnight trips.  This will allow the nurse ample time to plan for any students with special needs. Copies of forms for students indicating any special health care needs shall be forwarded to the nurse as soon as received to facilitate planning. For regular school day trips, the nurse shall receive a list of students participating in the trip at least one week prior to the trip to prepare for necessary medications or treatments.  For overnight field trips parents will provide a photocopy of their health insurance card. 

2.     Students who will require medication or treatments other than those normally received in school (e.g., medication taken at home after school, before or after meals or at bedtime, motion sickness medication needed for travel) must obtain a written doctor’s order and written parental permission for this medication on the appropriate form.  For overnight trips parents will be asked to secure a *“travel pack” from the pharmacy for these medications.



* A “travel pack” is the appropriate amount of medication for the trip in a pharmacy labeled container.


6153 (2) Side 1

Newington Public Schools

Extended Day Or Overnight Field Trip

Emergency/Information Form


The following information is required for each student going on an extended day or overnight field trip with a Newington Public School group.  This is a necessary form for chaperones to have completed and in their possession throughout the duration of the trip.  In case of an emergency, the policy will be for the chaperones to take appropriate action and then contact the parents.  Present hospital policy requires that we have an authorized signature of a parent or guardian before they will treat a patient.  Please complete all areas on the form.




I authorize any licensed physician to provide proper treatment, order injections, hospitalize, give anesthesia, or perform emergency surgery for:


Name: _______________________________________       Birthdate: ______________________________


While on a field trip from Newington, CT to ________________________  on  ___________     __________

                                                                                    (Destination)                 dates:   (to)                  (from)


I understand that this authorization is given prior to any need for medical care and is given to avoid unnecessary delay in emergency treatment which the physician my deem advisable in the exercise of his/her best judgement.  A reasonable attempt will be made to contact me at:


PARENT/GUARDIAN  ___________________________________________________

ADDRESS  _____________________________________________



PHONE   (HOME)    ___________________      (WORK) _______________ (CELL) ____________________

OTHER PERSON TO CONTACT ____________________________  RELATIONSHIP __________________

PHONE   (HOME)    ___________________      (WORK) _______________ (CELL)_____________________

KNOWN MEDICAL PROBLEMS: ______________________________________________________________

ALLERGIES (ESPECIALLY TO FOOD, MEDICATION, BEE STINGS)  ________________________________

SPECIAL DIETARY CONSIDERATIONS (Vegetarian, Gluten Free, etc.) _________________________________

DATE OF LAST TETANUS SHOT  ______________________________________



                           ___YES   ___ NO

If yes, please complete side two of this form

(Proper State of CT medication form must be filled out by parent and doctor for any medication dose or treatment student does not normally receive in school. Medication must be delivered to school in a properly labeled pharmacy container.)


CHILD’S PHYSICIAN  _________________________________________  PHONE  _______________________



INSURANCE PLAN  _____________________________________  POLICY NUMBER ____________________



SIGNATURE _______________________________ RELATIONSHIP ________________ DATE ____________


6153 (2) Side 2


Health Services

Medications on Extended Day or Overnight Field Trip Form


Dear Parent or Guardian,


            If it is necessary for your child to take medication during the school sponsored trip, please send the medication to the school nurse by __________________________ ( 1 week prior to field trip date).  The medications should be those that are medically necessary.  The medication MUST BE IN ITS ORIGINAL CONTAINER with your child’s name and the dosage and frequency.  A doctor’s written order should accompany the medication. 



Child’s Name _________________________________________________________________

Medication #1 ____________________________Dosage: ____________  Time: ___________

Frequency:________________            Special Handling:________________________________

Medication #2 ____________________________Dosage: ____________  Time: ___________

Frequency:________________            Special Handling:________________________________

            I give permission for my child’s teacher to administer the above medication if needed as I and my health care provider have indicated.  I provide ONLY enough medication for the duration of the field trip.


                                                                                    Parent/ Guardian Signature – Date


            The following EMERGENCY medications (such as an inhaler or an EpiPen) are self administered, as per doctor’s written authorization (REQUIRED AND ATTACHED):



Time of Administration:____________________________

Reason for Medication: ____________________________


If your child needs to carry an EMERGENCY medication – inhalers & EpiPens are the only medications a student may be allowed to carry on his/her person – please contact the school nurse to complete an additional required form.


                                                                                    Parent/ Guardian Signature – Date




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