Milner Gardens Field Trip Confirmation Form

This form is required to confirm your field trip. If you have not yet booked your field trip date or have not received the Milner Gardens K-12 School Program Safety Plan, please contact pamela.murray@viu.ca before filling out this form.

To ensure sufficient time to prepare for your field trip, this form must be completed a minimum of one week prior to your scheduled visit.

Date of Field Trip *

Month

Day

Year

Program Time *

Please specify requested program time *

Teacher Name *

Email *

Phone Number *

School *

Grade *

Please briefly explain the existing protocols for COVID-19 safety for your students when interacting with other members of their cohort while at school. *

Please briefly explain the existing protocols for COVID-19 safety for your students when interacting with people outside of their cohort while at school. *

I have received and read the Milner Gardens K-12 School Program Safety plan *

yes

I understand that during the field trip I am responsible for ensuring that my class, including accompanying adults, follows the Milner Gardens K-12 School Program Safety Plan *

yes

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