field trip guidelines and fundraising and travel guidelines 2010 -2011

8/9/2019 Field Trip Guidelines and Fundraising and Travel Guidelines 2010 -2011

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TABLE OF CONTENTS

Introduction... 1

Instructions for Requesting Fundraising ..... 2

FAQ Chart by Group ...3Other FAQ .. 4

Request for Approval of Fundraising Effort Form .... 6

Fundraising Collection Report ...8

Fundraising Activity Release and Indemnification ..9

Fiscal Transaction Instructions ..10

Check Request Form . 11

Cash Advance Form ..12

Deposit Form (for non-fundraising) .13

Fundraiser T-Shirt Deposit Form .14

Fundraiser Deposit Form (for fundraising) .15

Account Authorization for Student Activities Account .16

Guidelines for Other Sources of Fundraising Monies ..17

Individual Student Fundraising Monies ...20

Performing Arts Dept. Background and Guidelines forPerformance-Based Fundraisers ...22

Guidelines on Donations .24

Sample Donation Receipt Letter ..27

Facilities Use Guidelines ...28

Facilities Use Request Sample ....34

Guidelines for Concession Fundraising Operations .....35

Food Service Procedures for Fundraising ....38Concession Prices for Frequently Ordered Items . 40


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Field Trip Guidelines 42

Field Trips on Weekends 43

Overnight Activity Guidelines . 44

Off-Island Travel .. 45

Sleeping Arrangements During Travel ...46

Volunteer Chaperones . 47

Transportation Etiquette 48

Lodging Etiquette 49

Student Code of Conduct .. 50

Incident Procedures and Consequences 51

Responsibilities of Parent Chaperones . 52

Responsibilities of KS Adult Supervisors . 53

Emergency Contact Info Form .. 54

Field Trip and Travel Request Form 55

Aquatics Activity Request Form . 56

Off-Campus Water-Related Activity Safety Check List .. 57

Instructions to Staff/Advisor for Use of Permission toParticipate in Field Trip/Activity Release Form 58

Permission to Participate if Field Trip/Activity Release Form . 59

Notice and Acknowledgment of KS ProceduresGoverning Student Behavior While Traveling WithKamehameha Student Groups ..61

Notice and Acknowledgment of KS Policy GoverningWithdrawal of Travel Endorsement ...62

Acknowledgement and Receipt of KS Policy Governing Withdrawal of Travel Endorsement .63

Permission for Alternative Transportation 64

Permission to Leave the Group .65


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Request for Medical Information and First-Aid Kit For KS Field Trips/Activities ..67

Application to Volunteer Form .68

Returning KS Volunteer Tuberculosis Screening Questionnaire . 69

Authorization for Hale Ola TB Screening 70

TB Location Information .71


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INTRODUCTION

This manual is designed to address all groups who fundraise on theKaplama Campus. Please review the guidelines and procedurescarefully. These guidelines have been established according to KS Policyto ensure that proper behavior and protocol are maintained by allfundraising groups in order for Kamehameha Schools to maintain its tax-exempt status.

All organized student activities, including fundraising, which are directly orindirectly endorsed by KS, shall be coordinated by designated staff. Thiscoordination is required to assure that all activities are consistent with theoverall mission of KS, that specific reporting and approval procedures arefollowed and that the activity will reflect favorably on the KS family.

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Instructions for Requesting Fundraising

1. Fundraising requests may be submitted on a first come, first served basis. If you arerequesting fundraising dates for the following school year, please submit no earlierthan August of that year.

2. If you are fundraising for travel, your travel must be approved first. Please completethe Field Trip and Travel Request form to the Akahi Student Center. Please planahead being that the approval process may take some time.

3. If you are a new advisor/coach, please make an appointment with the Dean ofStudent Activities to review the fundraising guidelines. Failure to do this may delaythe approval of your fundraising request.

4. Complete the Fundraising Request form at least two weeks prior to the dates youare requesting and submit to the Akahi Student Center. If you are selling products

from another vendor, please attach a completed Indemnification Form. Failure todo this may delay the approval of your fundraising request.

5. Please indicate the dates you wish to fundraise. If you are fundraising on campus,you may request up to five (5) days per semester. If you would like additionaldates, please check with us on availability as we allow two groups to sell eachweek provided they do not sell the same products.

6. If your fundraising dates change, fundraising is canceled or you are makingchanges to the product(s) you are selling, please notify us immediately.

7. Once your fundraising activity is completed, please submit a fundraising collectionreport to the Akahi Student Center.

8. Please be sure to complete the appropriate forms if you need cash advances,check payments/reimbursements and deposits. Please refer to pages 11 through16 in this handbook for more information.

9. GIFTS SHOULD NOT BE PURCHASED FOR ANY INDIVIDUAL OR STUDENT USINGFUNDRAISED MONIES.

NOTE: Please note that money raised through fundraising efforts are considered the property ofKamehameha Schools and the school determines how the funds are to be spent. In the event of acancellation of an activity and/or travel, any fundraised monies are non-refundable. Only parentcontributions, not fundraised monies, may be returned to families.


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ATHLETIC CLUBS SANCTIONED CLUBS CLASSES Does my club need to have aclub charter sanctioned byASKS?

No Yes No. Howeverhead and the

Activities sIs my club required to haveby-laws?

No, only if the group is abooster club

No

Does my club need to submit

a club report?

No Yes, the club advisor should

submit at teacher check-out

Yes, the club

submit at tWho should sign off oncontracts?

Only the coaches and ADmay sign contracts

Only the club advisor andDean of Student Activities

Only thdepa

Who signs off on thefundraising request?

The coach and AD The club advisor and Dean of Student Activities

The teache

Who signs off on flyers,apparel designs and groupcommunications?

The AD and Dean of StudentActivities

The teacher and Dean of Student Activities

The teachStude

Can I use the KS logo? Yes as long as the item is notbeing sold for profit. Design

must meet specific use

requirements. Please contactCommunications Division for

approval.

Yes as long as the item is notbeing sold for profit. Design

must meet specific use

requirements. Please contactCommunications Division for

approval.

Yes as long being sold f

must me

requirementCommunica

aIf I want to do an overnightactivity, do I need to submit aField Trip and Travel RequestForm?

Yes. Please see Field Tripand Travel Guidelines found

in this manual.

Yes. Please see Field Tripand Travel Guidelines found

in this manual.

Yes. Pleasand Travel

in th

If I want to open an account,who needs to approve theAccount Authorization Form?

The AD and the Dean of Student Activities

The Dean of StudentActivities

The departmStudent Acti

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Other FAQ1. Can I request ATP funds?

Yes, you can request ATP funds. Applications are located in the Principals Office.

2. If I want to fundraise, what do I need to do?Complete a Request for Approval of Fundraising Effort form. Forms are located at the Akahi Studen

weeks prior to your requested fundraising date.

3. How long can I fundraise?If you are fundraising on-campus, you are limited to five days per semester. If we have extra weeks after everyoneaccommodated, you may inquire about additional fundraising weeks.

If you are fundraising off-campus, you may fundraise as often as you want for as long as you want. Please indicatyou intent to fundraise.

4. When do I need to submit the Fundraising Collection Report?Please submit two weeks after your fundraising period with all original receipts and invoices attached. The GET (

automatically deducted by the Student Activities Accountant.

5. What fundraisers are not subject to GET?Fundraisers which include pledge-type activities (i.e. jog-a-thons) and donation-type activities where services are nPizza Hut Nights, McDonalds Nights, Jamba Juice) are not subject to the GET.

6. I have a donation in excess of $250. What do I need to do?A donation receipt letter must be sent to the donator. Please contact Brian Chang ( brchang@letter. If the tax ID number is required, please contact Akahi Student Center at 842-8531. All donations should ba log of the name of donator, address, item donated and whether the donation was ackno

7. I want to sell food in the concession. What do I need to do?First check if the concession is available by calling 842-8532. If available, complete a Facilitieselling in t he concession need to go through training with Food Services. Please call 842-8997 to schedule a train

8. If we have a Student Activities Accountant (SAA), do I still need to keep track of my account?Yes. You should still be keeping track to ensure deposits and withdrawals are accurate. In addition, the SAA shoustatements to assist you in monitoring your account.

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9. How are fundraising weeks assigned?Fundraising weeks are assigned on a first come, first served basis. Fundraising requests for the following year mathan the first of August. If there are outstanding financial obligations from the previous year, this may delay approrequests for the following year.

10. Are there restrictions to the kinds of things our group can purchase?Any equipment purchases should first be discussed with the department head/AD to first determine if the purchasethe department budget or be provided by KS. If this is not possible, the group, with the approval of the departmenof Student Activities, may make the purchase knowing that it then becomes responsibility of the group (e.g lost/stomaintenance, etc.)

11. Are we allowed to give stipends to group volunteers?No, the funds should be for student-related activities not the volunteers.

12. Where can I get the forms to make deposits and withdrawals to my account?Forms can be found in the Akahi Student Center or may be downloaded at http://kapalama.ks

13. I have questions about my account. Whom do I call?For questions regarding your fundraising requests, fundraising collection reports and checks waiting for pick up, pCenter at 842-8531. For questions regarding your accounts financial status, please call the Student Activities Acc

14. When will I receive my account statements?Account statements will be issued by the Student Activities Accountants office by the 15 th ostatement than the one provided, please call 842-8694.

15. Can corporate sponsors pay for a students trip and use this as a tax deductible donation?A charitable contribution to a specific individual is not deductible.

16. Can we use fundraised monies to purchase senior gifts or mahalo gifts for coaches?No, gifts should not be purchased with fundraised monies for any individual. Gift purchases can only be made via

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REQUEST FOR APPROVAL OF FUNDRAISING EFFORT

DATE: _______________________________

TO: _________________________________

FROM: _______________________________________ ______________________________(Name of Group) Account No.

Purpose of Fundraising Effort (Describe in detail): _______________________________________

______________________________________________________________________________________

______________________________________________________________________________________(NOTE: Travel requests must be approved prior to submitting this request. Please refer to FieldTrip and Travel Guidelines)

AMOUNT TO BE RAISED: $__________________________

Means of raising money

Product: ____________________________ Vendor: _____________________________(Proof of purchase required two weeks prior to event)

Cost per Unit: _______________________ Items to be sold for: __________________

Packaging: _____Pre-Packaged _____ To be assembled in Board of Health certified facility

Means of distribution: _________________________________________________________________

Solicitations will be made from the following groups (Example: friends, students, parents, etc.).Please list:

______________________________________________________________________________________

Solicitations will be made:

On and off campus ______ Off campus only _____ On campus only ______

WE UNDERSTAND THAT NO SOLICITATION WILL BE MADE OF ANY MEMBER OF THE BOARD OF TRUSTEESOF KAMEHAMEHA SCHOOLS

Period of fundraising (NOTE: No more than five (5) school days may be allowed for on-campusfundraising):

1st Choice: From _______________ to _______________2nd Choice: From _______________ to _______________3rd Choice: From _______________ to _______________

KS Services and/or Facilities required: __________________________________________________

______________________________________________________________________________________

NOTE: Work Requests and Facilities Use Request forms must be submitted upon approval.

-Continued on Back-

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After completing the fundraising activity, a Fundraising Collection Report must be submitted to theDean of Student Activities (KHS), Student Activities Coordinator (KMS), or to the KES Principal. The4.5% GET will be automatically deducted by the Student Activities Accountant.

I have read the Fundraising Handbook and will comply with the conditions contained in it.

_____________________________________ _____________________________________Advisors/Coachs Name (Please Print) Advisors/Coachs Signature

Mailing Address: __________________________________________________

__________________________________________________

__________________________________________________

_______________________ _______________________Telephone No. (Work) Telephone No. (Home)

ACTION:

____________________________________________________________________ ______________Athletic Director/Department Head Signature Date

____________________________________________________________________ ______________Dean of Student Activities/Student Activities Coordinator/KES Principal Date

____________________________________________________________________ ______________Director of Food Services Date

REVISED 10/08

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KAMEHAMEHA HIGH SCHOOL

Fundraising Collection Report

Date: _________________________

TO: ___________________________

FROM: Name of Group ________________________________________________________

Account No. _________________________________

Advisor/Coach _____________________________ Telephone ________________

RE: Project ________________________________________________________________

Date(s) Held ___________________________________________________________

Gross Receipts$ _________________(A)

NOTE: Where applicable, the 4.5% general excise tax will automaticallybe deducted by the Student Activities Accountant.

EXPENSES:

Item AmountGeneral Excise Tax

$ __________________

_________________________________________ $ __________________

_________________________________________ $ __________________

_________________________________________ $ __________________

_________________________________________ $ __________________

TOTAL EXPENSES .$ _______________ (B)

NET PROFIT ..$ ______________ (A-B)

COMMENTS (if any):

Received By: _________________________________________________ Date _________________(Please return to Dean of Student Activities (KHS), Student Activities Coordinator (KMS), orPrincipal (KES) within two weeks of the completion of your activity.)

**IF ORIGINAL RECEIPTS WERE SENT TO THE STUDENT ACTIVITIES ACCOUNTANT, PLEASE ATTACH A COPY OF THERECEIPTS TO THIS COLLECTION REPORT. THANK YOU!**

Revised 5/09

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The following are four forms that are to be used for recording your fiscal transactions:

1) Kamehameha Schools Student Activities Kaplama Check Request Form (Exhibit A) Please utilize this form for all check requests. Please provide adequate details when completing the event, description and

expense type to ensure the accurate recording of the expense as well as theproduction of meaningful reports.

This form is subject to the following tiered approval levels:

Tier 1 Requests under $1,000 Form requires approval of the club advisoronly

Tier 2 Requests for $1,001 to $5,000 Form requires Tier 1 approval plus therespective dept. head approval

Tier 3 Requests for $5,001 and above Form requires Tier 2 approval plus therespective Student ActivitiesCoordinator/Dean

These forms should be submitted to the Athletics Department, Elementary SchoolOffice, Middle School Student Activities Center or Akahi Student Center.

We are committed to processing all requests within five (5) business days (aslong as request is submitted to the appropriate location mentioned above by8:00 a.m.).

In order to meet this turnaround time all requests must be submitted with theproper approvals.

All processed checks will be delivered back to the office to which they wereoriginally submitted.

Group advisors will be asked to sign out for their check.

2) Kamehameha Schools Student Activiites Kaplama Cash Advance Form (Exhibit B) Please utilize this form for all cash advances. Cash advances should only be made in situations where a check request could

not be used. All cash advances require Tier 3 approvals regardless of the amount being

requested. The approval form should be presented in person to the Student Activities

Accountant for receipt of the cash requested.

3) Kamehameha Schools Student Activities Kaplama Deposit Form (Exhibit C) Please utilize this form for all non-fundraising deposits Deposits on this form will not be subject to the Hawaii State General Excise Tax Select the appropriate box in the right hand column for all deposits to ensure

that accurate recording of the deposit as well as the production of meaningfulreports.

4) Kamehameha Schools Student Activities Kaplama Fundraiser Deposit Form (Exhibit D) Please utilize this form for all fundraising deposits Deposits on this form will be subject to the Hawaii State General Excise Tax Serves as your cash receipt listing (remember PII), inventory reconciliation and

deposit form


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K AMEHAMEHA S CHOOLS

KAMEHAMEHA SCHOOLS STUDENT ACTIVITIES KAPLAMA

CHECK REQUEST FORM

Date: Account #: Athletics DepartmentElementary School, Rachel Lee

Name: Middle School, Student Act Ctr High School, Student Act Ctr

Club:

Check payable to:

Address: Payment

City, State, Zip: Reimbursement

Event Description Amount Expense Type (Senior Lau ) (Food) (Events-meals)(Car wash fundraiser) (Car wash supplies-soap, towels, buckets) (Fundraiser supplies)

*Payment made to other KS Student Activity Clubs will not generate a check; process will occur as an internal transaction.***All original invoices and receipts are attached.**

TOTAL

Approved by :(Advisor) Print Name Signature Date Phone/Email

Approved by :(Department Head) Print Name Signature Date Phone/Email

***If amount is more than $1,000.00, second approval by Department Head required***

Approved by :(Dean of Student Activities/Student Activities Coordinator) (Date)

****If amount is more than $5,000.00, approval by Student Activities Dean/Coordinator required****

By your signature, you are certifying that you have reviewed the transaction and related documentation and they conform to KamehamehaSchools (KS) policy and that the transaction is within budget, free from known conflict of interest and in the best interest of KS.

For KSSA Office Use Only Expense Acct:

Date: Amount:

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CASH ADVANCE FORM

Date: Account #: Athletics DepartmentElementary School, Rachel Lee

Name: Middle School, Student Act Ctr High School, Student Act Ctr

Club:

Check payable to:

Address:

City, State, Zip:

Event Description Amount Expense Type (Senior Lau ) (Food) (Events-meals)(Car wash fundraiser) (Car wash supplies-soap, towels, buckets) (Fundraiser supplies)

*All original invoices and receipts are attached. All change to be reimbursed to Student Activities accountant.*

TOTAL

Approved by :(Advisor) Print Name Signature Date Phone/Email

Approved by :(Department Head) Print Name Signature Date Phone/Email


**Cash Advance requires approval by the Club Advisor, Department Head, and Student Activities Dean/Coordinator**

By your signature, you are certifying that you have reviewed the transaction and related documentation and they conform to KamehamehaSchools (KS) policy and that the transaction is within budget, free from known conflict of interest and in the best interest of KS.

For KSSA Office Use Only Expense Acct:

Date: Amount:

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KAMEHAMEHA SCHOOLS

KAMEHAMEHA SCHOOLS STUDENT ACTIVITIES KAPLAMA DEPOSIT FORM

Date: Account #: Athletics DepartmentName: Elementary School Offc, Rachel LeeEmail: Middle School, Student Act CtrClub: High School, Student Act CtrEvent

P a r e n

t A s s e s m e n

t

Cash orCheck # Payer Student Name Amount D o

n a

t i o n

D u e s

A T P G r a n

t

Other (Please provide explanation)

Cash

Cash

CashCash

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Cash Collected - Checks Collected -

Total Amount Collected -

Page 1

Please Retain a Copy for your Records


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KAMEHAMEHA SCHOOLS


FUNDRAISER DEPOSIT FORM

Name: Email:Club: Date:

Event: Account #:

Beginning Inventory - - - - -

Tot

Student's Name Quantity Cost/Item Quantity Cost/Item Quantity Cost/Item Quantity Cost/Item Quantity Cost/ItemCASH - -$ - -$ - -$ - -$ - -$ $

1 $

2 $

3 $

4 $

5 $

6 $

7 $

8 $9 $

10 $

11 $

12 $

13 $

14 $

15 $

16 $

17 $

18 $

19 $

20 $

Ending Inventory - - - - -Actual Inventory - - - - -

Variance - - - - -

Variance Explanation

Signature Date

*Hawaii General Excise Tax (4.5%) will be automatically calculated and remitted from the deposit total.

Please Retain a Copy for your Records


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ACCOUNT AUTHORIZATION FOR STUDENT ACTIVITIES ACCOUNT

Athletics Department Middle School (Date) Elementary School High School

(Clubs Name)

Please Open an Account

Clubs Purpose:

Advisor(Print Name) (Signature) (Phone) (Email)

has signed a statement acknowledging the forms and procedures pertaining to the use of a Kamehameha

Schools student activities account will be adhered to as outlined in the Student Activities Handbook.

Please Close our Account

Reason for closing account:

Instructions for Remaining Funds:


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fundraising activity). Donations are part of your income and should belogged as such; they are not part of your expenses and should not beincluded when calculating your GET tax.

b. Donations received for services are subject to GET tax (e.g. gift wrapping,Honolulu Marathon, etc.).

c. If you need to issue contribution receipt letters to those who have madedonations, please email ([email protected]) an excel spreadsheet toinclude name, address, city, state, zip code, description of donation,purpose of donation. Contribution letters will be drafted and sent to you.

Everyone should be advised of the following policies:

1. All requests for fundraising MUSTindicate products to be sold. Any changesmust be reported to Akahi Student Center (KHS) or Principals Offices (KMSand KES).

2. All forms of publicity (posters, flyers, commercials on Puka Mai Ka L, etc.)must have approval from the Dean of Student Activities. Please allow 1 2weeks PRIOR to publicizing event to account for any corrections and/orapproval.

3. Daily Bulletin announcements should be submitted by 9:00 am the day beforeit is to appear in the bulletin. NO EXCEPTIONS . Bulletin announcementsshould be signed by the clubs advisor.

4. Clubs are allowed to fundraise only within the designated period. FAILURE TO

DO SO MAY RESULT IN PRODUCTS BEING CONFISCATED AND/OR FUNDRAISINGBEING DENIED.

5. It is the club advisors responsibility to monitor students and remind them ofappropriate fundraising procedures.

6. Selection for fundraising dates will be on a FIRST COME, FIRST SERVED BASIS.THIS IS A CHANGE IN POLICY FROM PREVIOUS YEARS. The Request for Approval of Fundraising Effort may be submitted no earlier than the first ofJune as long as all GET taxes and year-end financial reports have been filed.FAILURE TO DO THIS MAY RESULT IN THE DELAY OF APPROVING FUNDRAISINGREQUESTS.

MONITORING THE ACCOUNT

1. After fundraising efforts are complete, all funds raised should go directly intothe clubs checking account using the appropriate deposit form (pp. 13 15). DO NOT KEEP CASH in an office, home, or classroom. ANY STAFF MEMBER

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WHO DISREGARDS THIS POLICY WILL BE PERSONALLY RESPONSIBLE FOR ANY FUNDS THAT ARE STOLEN FROM HIS/HER CLASSROOM, HOME OR OFFICE .

2. Check requests should be made in advance . Please allow at least a weekfor your check to be processed.

3. INDIVIDUALS SEEKING REIMBURSEMENT FOR PURCHASES, INVOICES, ETC. MUSTSUBMIT AN ORIGINAL RECEIPT OR INVOICE ALONG WITH THE REQUEST.

4. Please keep accurate records of all deposits and expenditures. Accountrecords may be requested by the Dean of Student Activities for auditingpurposes.

5. General excise taxes will automatically be deducted from your account bythe Student Activities Accountant.

6. A Recognized Organization Tax Questionnaire will be distributed to you at theend of the year. This form must be completed no later than the end of thefiscal year (July). Failure to complete the form may impact the approval ofactivities/fundraising for the following year.

NOTE: REGARDLESS OF WHO INITIATES FORMS, COACHES/ADVISOR, AND IN THECASE OF ATHLETICS, THE ATHLETIC DIRECTOR MUST SIGN OFF ON FORMS (e.g.facilities use requests).

NOTE #2 : Please note that money raised through fundraising efforts areconsidered the property of Kamehameha Schools and the school determines

how the funds are to be spent. In the event of a cancellation of anactivity and/or travel, any fundraised monies are non-refundable. Only parentcontributions, not fundraised monies, may be returned to families.

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INDIVIDUAL STUDENT FUNDRAISING MONIES

A portion of the revenues from designated fundraisers may be credited tothe appropriate students account provided that the following is applied:

1. Monies raised must be used specifically for the purpose approved bythe Student Activities Office. If the activity is cancelled, all monies mustremain in the individual account and will be transferred to the groupsgeneral fund at the end of the school year.

2. Under no circumstances shall any funds be used for non-studentactivities (e.g. staff stipends, parent travel, spending money, etc.). Allmonies are to be spent for the direct benefit of the groups students.

3. No approval for funds to be transferred to other group functions, otherstudents, siblings, or other activities will be allowed.

4. No individual checks will be issued to the student at the end of theschool year for any remaining balances. All funds will be transferred tothe groups general fund at the end of the school year.

5. All payments must be reconciled before any monies are credited ordisbursed to the students or their accounts. This includes any balancesowed for fundraising projects, returned check fees, etc.

6. In the event a student drops the class or organization, or is dismissedfrom Kamehameha, the students account will be closed and allfundraising monies should be transferred to the groups general fund.If a student is reinstated, funds transferred to theclubs/teams/organizations general fund will not be re-credited to thestudents account

7. Fundraising monies should be used strictly to subsidize studentsrequired fees (airfare, food, lodging, etc.)

8. Students may not fundraise for trip spending money or for parenttravel costs.

9. Upon completion of trip, any left over funds in the students accountmay be used for group-sponsored events for the remainder of thatschool year only with the approval from the Dean of Student Activities(KHS), Student Activities Coordinator (KMS), or Principal (KES).

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10. In a non-travel year, funds in student accounts may be used, subject tothe approval of the Dean of Student Activities (KHS), Student ActivitiesCoordinator (KMS) or Principal (KES), for group-sponsored activities(e.g. camps, uniforms, tournament tickets, etc.).

11. Alternative uses for funds may be possible only with the approval of theDean of Student Activities (KHS), Student Activities Coordinator (KMS),or the Principal (KES).

12. Should donations be made to the account, it should be labeled assuch in the students individual log. If there are leftover monies in theaccount at the end of a students senior year, only donated monies ordeposits may be returned. Any fundraised monies should go into thegroups general account.

NOTE: Please note that money raised through fundraising efforts areconsidered the property of Kamehameha Schools and theschool determines how the funds are to be spent. In the event of acancellation of an activity and/or travel, any fundraised monies arenon-refundable. Only parent contributions, not fundraisedmonies, may be returned to families.

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a. To provide enrichment opportunities not covered by the Schools,such as: End of the year banquets/culminating activity Achievement awards/letters/jackets Some guest speakers/clinicians Supplementary uniforms Some afterschool meals and snacks Some admission fees to community plays, symphony

concerts, operas, recitals, etc.b. To help defray the cost of enrichment travel.

5. The Performing Arts Dept. budget covers the basic cost of supplies andservices to operate at a level consistent with performing arts departmentsnationally. However, the level of quality and output expected fromKamehameha Schools is decidely higher than other local high schools,public or private, and is acknoweldged as being above the national norm

for high school performing arts departments. Therefore, to meet thisdemand, staff, students and families are expected to provide their ownsupplementary resources in the form of volunteerism, donation of services,out of pocket funds and devotion of personal time.

Guidelines

1. All department-sponsored performances on-campus for which anadmission fee is charged must be approved by the Dean of StudentActivities as a fund raising event.

2. All accounting and applicable taxes must be handled inaccordance with Student Activities fund raising guidelines.

3. All proceeds are to be deposited in the respective club accountsmanaged by the Student Activities Office.

4. The Performing Arts Department recommends that admission feesnot exceed $5/adult and $3/student for department-sponsoredevents.

5. When possible/practical, special consideration may be given to KSstudents and staff by offering exclusive performances and/or byoffering either a discounted or complimentary admission fee.

Please feel free to contact the Performing Arts Department Chair, at 842-8975 if there are questions or for more information.

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rocedures for use of KS Campus Facilities

Policy 255 Facilities UseProcedures for use of KS Campus Facilities

A. Responsibilities, Prohibited Activities and General Rules for KS Facilities Use B. Acceptable Types of Facilities Use and Scheduling Priorities C. Procedures for Use of KS Campus Facilities D. Pedestrian Agreement for Walkers/Joggers E. Forms

A. Responsibilities,Prohibited Activitiesand General Rules for KS Facilities Use

KS Responsibilities

1. The Headmaster, through the campus operations office, is authorized todevelop the day-to-day implementation of procedures governing the useof campus facilities.

2. The CEO or his/her designee may grant exceptions to establishedprocedures when the best interests of KS would be served by anexception.

User s Responsibilities

Users:

1. Must designate an individual who will be on site and responsible for theconduct of the user s members and guests during the function. KSreserves the right to end an activity and/or to direct individual(s) to leavethe campus.

2. Are responsible for damages or losses to KS property resulting from theuse of campus facilities.

3. Are responsible for their own clean-up after usage unless prior arrangements have been made. Groups will be billed for applicablecustodial charges.

4. Must follow all rules and regulations. Failure to comply may result in loss

of future use of facilities.

Prohibited Activities

1. Use of Alcohol: The distribution, sale, possession or consumption of alcoholic beverages is prohibited in all campus facilities. However,consumption and possession of alcoholic beverages in private residencesis permitted, when approved in writing by the Headmaster. All users areresponsible for the conduct of their members and guests at events andactivities scheduled in campus facilities.

le:///E|/Procedures%20for%20use%20of%20KS%20Campus%20Facilities.htm (1 of 6) [12/9/2008 12:21:23 PM]

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2. Smoking is prohibited in all campus facilities except in designatedsmoking areas.

3. Personal use of campus facilities: Use of campus facilities for activitieswhich are operated for personal benefit and/or profit are prohibited, exceptfor personal uses noted in policies for the Chapel and facilities used bystaff for recreatio nal purposes.

General Rules

1. The use of all campus facilities must be in compliance with all applicableCounty ordinances, State and Federal laws, and established KS policiesand procedures. Failure to observe any statues, ordinances, laws or policies and procedures may result in suspension of privileges.

2. The omission of any rules, practices or policies and procedures from thisdocument does not mean they do not apply. Rules, practices and policiesand procedures contained in other KS official publications and documentsapply to the use and scheduling of campus facilities as applicable.

3. Any use of a campus facility which interferes with KS activities will not beallowed.

4. The use of campus facilities for an event where food is to be consumed,distributed or sold may occur only when in compliance with Policy 253[C] -Use of Food Services or Food Services Facilities at all KS Sites.

B. Acceptable Types of Facilities andScheduling Priorities

1. Acceptable Types of Facilities Usea. The primary purpose for KS campus facilities is to support the

educational mission of KS.b. Activities of KS-related programs and non-KS organizations are

allowed use of campus facilities subject to the conditions set forth

in these procedures, if they:i. do not interfere with, delay or conflict with the normal

operations of KS;ii. are directly related to the educational mission of KS;

iii. comply with certain requirements before using the campusfacilities; including requirements for insurance andindemnification and

iv. pay any direct expenses associated with the use.2. Scheduling Priorities for Use of Campus Facilities

a. Campus facilities, including the grounds, are provided primarily for KS programs and the activities necessary for the support of theseprograms. These programs have priority over any other use.

b. KS-related programs have the second highest priority for use of campus facilities.

c. Use of campus facilities by Non-KS organizations is subject to theneeds and convenience of KS.

d. Staff person use of recreational f acilities is of the lowest priority.


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C. Procedures for Useof KS CampusFacilities

1. When to Use a Facilities Use Form (FUR)

A FUR is not required for routine program facilities use: Regularlyscheduled classes during the school day DO NOT require aFacilities Use Request form ("FUR").

A FUR is required for non-routine facility use: Non-routine activities

during school hours, e.g., assemblies, concerts, conferences, etc.,or any activities outside the regular school day DO REQUIREsubmittal of a FUR.

Additional forms may be required for services associated withcampus facilities use, i.e., Work Orders, A.V. Service Requests,Food Service Requests, etc. Call the facilities manager or thecampus operations office with questions.

2. Where to Obtain the Facilities Use Request (FUR) Form

Facilities U se Request forms are available from Unit Offices, Principals'Offices or from the Operations Office.

3. Facilities Use Request Deadline

FUR must be submitted to the campus facilities manager or the campusoperations office at least 14 calendar days prior to the event.

4. Time Limit for Reservations

The maximum period for reserving a campus facility for a recurringreservation (e.g., a weekly meeting) is usually three (3) months.Reservations must b e expressed as DATES, NOT "every Monday"

5. Routing the Facilities Use Reques t

Route requests as follows (keep a photo copy of completed form for reference):

a. To the principal/division director of the reque stor.b. To the campus facilities manager who will check with theappropriate scheduling coordinator to determine the availability of the requested facility. Once approved, a copy of the FUR form isreturned to the requestor and scheduling coordinator.

6. Review of Facilities Use Request (FUR) at Event

A copy of the approved FUR form must be available for inspection bySecurity during the entire use of the campus facility.


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7. General Liability and Indemnification Requirements for Related and Non-related Programs

General Liability Insurance

All programs must obtain and submit evidence of a commercial generalliability insurance policy naming KS and the Trustees as additionalinsured. The cost of this commercial liability insurance is the responsibility

of the group. Specific requirements for this insurance are detailed on theInsurance and Indemnity Requirements for Facility Use information sheet.For more information see Policy 540[C] Risk Management and Safety.

The insurance must cover the entire KS campus facility made available for use to the program, and must provide that the policy cannot be canceledwithout giving KS at least 30 days written notice of cancellation.

NOTE: A sample Certificate of Insurance is included and should be madeavailable for users to show their insurance agents KS's requirements.

Indemnification Statement

An authorized representative from programs using campusfacilities must sign and return the KS Indemnification Statement.

The Certificate of Insurance and the Indemnification Statementmust be submitted to the facilities manager or the campusoperations office at least 14 calendar days prior to use of any KSfacility.

The Release and Indemnification By Faculty and Staff Making

Unsupervised Use of Kamehameha School Recreational Facilities form must be completed by faculty and staff who are allowed touse KS recreational facilities without supervision.

8. Determining and Recovering Facility Use Charges Created by Facilities

Use

KS Divisions and Departments:

KS Divisions and Departments are not charged a fee for the use of campus facilities when the meetings or activities are a direct part of their regular activities. Programs may be charged for directpersonnel costs arising from their use of a facility, e.g., extrasecurity for directing traffic, etc.

Direct costs are billed through the inter-departmental billingsystem.

The department s director or fiscal officer is responsible to verifycharges. Discrepancies should be reported immediately to thefacilities manager or the campus operations office.

KS Recognized Organizations:


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E. Forms 1. Facility Use Request 2. Insurance and Indemnity Requirements for Facility and/or Site Use 3. Certificate of Liability Insurance 4. Indemnification Statement 5. Release and Indemnification by Faculty and Staff Making Unsupervised

Use of KS Recreational Facilities 6. Annual Pedestrian Registration Agreement

Back to Policy Page

Page Managed by: Leah Mariani Last Updated: 2/26/2007

2001 Kamehameha Schools. All rights reserved. Statements of Privacy, Copyright, and Disclaimer.


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FIELD TRIPS

Field Trips (trips that are occurring during the school day and/or are part of classcurriculum):1. All field trips are to be approved at a quarterly meeting.2. First quarter field trip requests are submitted to the committee no later than one

week after the quarter begins. Second, third and fourth quarter requests are tobe submitted one week before the start of each quarter. Please use the Field Trip and Travel Request Form and include all necessary paperwork.

3. The Field Trip Committee: 1) consists of one member per department; 2) willinclude a rotating Unit VP; 3) serves for one year and meets once per quarter; 4)members will be recommended by the department head.

4. Field trips can be held during the school day only when the location of the fieldtrip cannot be visited on a weekend or evening (i.e. visits to courtrooms,legislative meetings) or when an outstanding guest is available for a limitedtime.

5. Teachers must justify the reason for each field trip as well as why it cannot beheld on a weekend (See Field Trip and Travel Request Form ).

6. Provide for an alternative activity in case a student cannot go (See Field Trip and Travel Request Form ).

7. If students will be in, around or near water (e.g. loi, beach, pool, etc.) anAquatic Activity Request form must be included in the packet as well.

8. Depending on its nature, field trips fewer than twenty-five (25) people may notrequire an additional chaperone. All field trips with twenty-five (25) or morepeople require at least one (1) chaperone in addition to the teacher.

9. All student work for classes missed on the day of the field trip is to be handed in

prior to going on the field trip.10. Students must adhere to the school dress code when on a field trip. Exceptionsmust be approved by the vice principal.

11. A supplemental meeting is to be scheduled, if necessary, to hear any appealsfrom teachers whose trips have been denied.

12. Approved field trips will be listed in the Daily Bulletin.13. Students with ten (10) absences per semester will not be permitted to attend a

field trip.14. The teacher/advisor requesting the trip and the department head should sign the

request.15. The Field Trip and Travel Request Form , along with necessary documents,

should be sent to Akahi Student Center. Please do not send TransportationRequests or Food Service Requests. Those forms should be processed by you oryour department clerk once your trip has been approved.

16. Akahi Student Center will route the packet to the appropriate vice principal.The appropriate vice principal will notify the teacher if the trip has beenapproved.

17. Once the trip is completed, all permission forms should be submitted to AkahiStudent Center.

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FIELD TRIPS ON WEEKENDS

1. The Field Trip and Travel Request Form , along with necessary documents,should be sent to Akahi Student Center. Please do not send TransportationRequests or Food Service Requests. Those forms should be processed by you oryour department clerk once your trip has been approved.

2. If students will be in, around or near water (e.g. loi, beach, pool, etc.) anAquatic Activity Request form must be included in the packet as well.

3. The teacher/advisor requesting the trip and the department head should sign therequest.

4. The first aid kit request along with a roster must be completed as part of thepacket.

5. Depending on its nature, field trips fewer than twenty-five (25) people may notrequire an additional chaperone. All field trips with twenty-five (25) or morepeople require at least one (1) chaperone in addition to the teacher.

6. Akahi Student Center will notify the teacher if the trip has been approved.7. Once the trip is completed, please submit all permission forms to the Akahi

Student Center.

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OVERNIGHT ACTIVITY GUIDELINES

For overnight activities that occur on campus/on Oahu: Prior to the activity, a letter must be submitted to all parents listing the following

information: Purpose of the overnight activity Date, time and location Staff in charge of activity Emergency contact numbers Student behavior guidelines Parent permission forms

Staff members in charge must review student guidelines and expectations to ensurestudent safety and accountability. All school rules are to be followed and applied.

Students should be made aware of the appropriate check-in time. All late arrivalsshould receive prior approval from the staff member in charge of the activity. Once

the late check-in time has been determined, no students should be allowed to enter orleave the sleepover area. Male and female students should sleep in separate areas. Staff and parent supervisors

who are assigned to monitor student behavior during sleep hours must be of the samegender. Adult supervision ratio should be one (1) adult to 20 students.

Following the overnight activity, all students must be transported home by aparent/guardian. Exceptions to this must be made to the teacher in writing in advanceand signed by the parent/guardian. The staff member in charge must be sure to checkstudents out to the appropriate parent/guardian responsible for pick-up. All KS staff areresponsible for the supervision of students for half an hour from the end time of asleepover event.

Staff members in charge of the overnight activity must follow all Facility UseGuidelines to ensure that facilities are well kept and maintained.

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OFF-ISLAND TRAVEL

1. Complete the Field Trip and Travel Request Form. This form must be completed nomatter when the travel is occurring (weekends, holidays, vacations and/or summer).

2. The advisor/coach/teacher requesting the trip and the department head should sign therequest.

3. Send form, along with required documents, to the Akahi Student Center. Please notethat a completed template of the Permission to Participate in Field Trip/Activity andRelease Form must be submitted as part of the required documents. Per KS Policy andGuidelines, the Permission to Participate in Field Trip/Activity and Release Form isinitiated when a KS staff member/advisor is planning field trips/activities that occuroutside of the normal school day hours (e.g. weekend overnights, neighbor island orout-of-state travel).

4. If students will be in, around or near water (e.g. loi, beach, pool, etc.) an AquaticActivity Request form must be included in the packet as well.

5. If requesting a first aid kit, an additional roster should be included in your packet.6. The Dean of Student Activities will review the request and verify if all financial

obligations (if necessary) have been completed. If so, the Dean will send the requestto the Administrative Team for approval.

7. The Administrative Team will review the request; if the field trip does not affect schooldays, the request is sent to the principal for approval. If the request affects schooldays, then the request is forwarded to the Field Trip Committee (see Field Trip).

8. If the Field Trip Committee approves the request, it is then sent to the principal for finalapproval. Principal will then route the form back to the Akahi Student Center. AkahiStudent Center will notify the advisor that the trip has been approved.

9. If a group is also requesting ATP funds, the approved Field Trip and Travel Request

Form should be attached to the ATP request as verification that the travel has beenapproved by the principal.

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SLEEPING ARRANGEMENTS DURING TRAVEL

1. Prior to the activity, a letter must be submitted to all parents listing the followinginformation: Staff in charge of activity Emergency contact numbers Student behavior guidelines Parent permission forms

2. Staff members in charge must review student guidelines and expectations to ensurestudent safety and accountability. All school rules are to be followed and applied.

3. Students should be made aware of the appropriate check-in time. All late arrivalsshould receive prior approval from the staff member in charge of the activity. Oncethe late check-in time has been determined, no students should be allowed to enter orleave the sleepover area.

4. Male and female students should sleep in separate areas. Staff and parent supervisors

who are assigned to monitor student behavior during sleep hours must be of the samegender. Adult supervision ratio should be one (1) adult to 20 students.

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PARENT VOLUNTEER CHAPERONES

1. Volunteers who are assisting KS staff must have completed an Application to Volunteer for KS form, th e Authorization to Conduct Criminal History Record Check/Statement of Understanding form and tuberculin skin test.

2. It is the responsibility of the staff member in charge of the activity/function to ensure allvolunteers have been cleared. Cleared parents will have a volunteer card issued by ParentAlumni Relations (PAR). You may also call 842-8659 to verify if your volunteers have beencleared.

3. Volunteers should not have responsibility for students without a staff member present in thesame room or area and is always in visual contact with the Volunteer.

4. Please have parent mail form directly to the address listed. In order to comply with our PIIpolicy, do not collect the form yourself.

5. For further questions regarding the volunteer policy, please refer to Policy 223(C) Policy onVolunteers at Kamehameha Schools.


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TRANSPORTATION ETIQUETTE

Airplane Guidelines: Be prompt! Check in early. Checked luggage should measure no more than 62 and weigh no more than 50

pounds. Be courteous of other travelers on the aircraft and refrain from excessive noise and

loud talking. Be mindful of your belongings, especially your ID, airline tickets, medical card,

money and other valuables. Upon arriving at your destination, do not be in a rush to deplane. Take your time

to check under the seats, in the seat pockets and overhead compartments for yourbelongings.

Bus Guidelines: Be prompt! Buses need to leave on time. Treat your driver with courtesy and respect. Keep in mind that SAFETY is the

drivers main concern. Keep head, arms and legs inside the bus. Remember, throwing objects inside or

outside of the bus is prohibited. Remain seated while the bus is in motion. Buses must be kept clean. Food and drinks may be taken and consumed while

traveling ONLY IF allowed by bus officials.

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LODGING ETIQUETTE

Be in your room 30 minutes prior to lights out time. Be certain lights are out andyou are quiet.

While in your room be courteous of others. Hallways and walls carry sound so pleasebe a good neighbor. Remember, making noise or disturbing others by running downcorridors will not be tolerated.

Keep your room locked at all times. Know who has the key. Keep track of personalbelongings. Leave valuables at home. Lock your suitcase when leaving your room.Open your door only if you know who is on the other side. Even if they identifythemselves as hotel employees, do not open your door. Call the front desk and ask if someone from their staff is supposed to have access to your room and for whatpurpose. Call your chaperone and inform him/her of the situation.

Close the door securely whenever you are in your room and use all of the lockingdevices provided.

Please leave hotel linen, furnishings and any other items when you leave. Be aresponsible guest by keeping your room in proper order. You will be financiallyresponsible for any loss or damages.

When returning to your lodging late in the evening, use the main entrance. Beobservant and look around before entering parking lots.

If you see any suspicious activity, please report your observations to your chaperone. Be cautious about displaying guestroom keys in public or carelessly leaving them on

restaurant tables or other places where they can be easily stolen or forgotten. Telephone usage should be kept to a minimum. You will be assessed for any phone

calls that are made when you check out.

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STUDENT CODE OF CONDUCT

We place great faith in our students. We believe they are capable of being exemplaryambassadors. However, there have been situations in the past where a single person hasnegatively impacted the group as a whole.

We expect our students to: Behave in a manner that reflects positively on Kamehameha Schools and the group

that your are traveling with. Be honest, caring, respectful, dignified, hardworking and use common sense. Comply with all KS expectations as outlined in the Kamehameha Student/Parent

Handbook.

MAJOR INFRACTIONS

Safety and Well-Being1. Safety of individuals jeopardized2. Property damage (hotel, airline, public/private property)3. Theft4. Any unauthorized departure from lodging; any unauthorized departure from premises5. Violent or over-aggressive behavior6. Knowledge of major infraction/potential violations but failure to make a report

Sexual Behavior/Disregard for Privacy1. Sexually intimate behavior2. Public displays of affection (behavior that may make others feel uncomfortable)3. Sexual harassment4. Entering rooms of the opposite sex

Substance Abuse1. Smoking/chewing tobacco, etc.2. Partaking in or possession of alcohol or any unauthorized medication3. Partaking in or possession of any illegal substances4. Possession of drug paraphernalia

Insubordination

1.

Verbally abusive behavior2. Physically abusive behavior; fighting3. Disrespect towards adults or students4. Flagrant disrespect for hosts, elders or KS staff 5. Flagrant violation of KS rules6. Inappropriate conduct when part of a school-related activity

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INCIDENT PROCEDURES AND CONSEQUENCES

1. The incident will be addressed on the spot by any KS adult supervisor and/orchaperone.

2. Report infraction to the appropriate chaperone who will notify the adult in charge.3. If necessary, parents and school officials will be notified.4. Consequences for infractions can be found in the Student/Parent Handbook.5. If infraction requires that the student be released from the group, parents will bear the

cost of the return ticket to Oahu.

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RESPONSIBILITIES OF PARENT CHAPERONES

Parent chaperones assist the group by providing security, guidance and coordination forassigned students throughout the trip. All parent chaperones must complete the KSApplication to Volunteer form prior to the trip. The process involved a TB test andCriminal Background check so please check with the PAR Office (842 8659) or StudentActivities (842-8531) to verified if you have been cleared to participate.

Discipline Issues: Any discipline issues should be handled by KS adult supervisors and/oradministrators.

Medical Emergencies: Refer any medical concerns to the KS adult supervisors and/oradministrator. The KS adult supervisor(s) should have medical information for eachstudent traveling with the group at all times.

Student Information: Chaperones must carry with them, at all times, each of theirstudents medical information.

General Expectations: While traveling with the group, it is prohibited to consume alcoholfor the duration of the trip. If you become under the influence of prescription drugsand/or over-the-counter medication for medical illness, please notify the KS adultsupervisor in charge.

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RESPONSIBILITIES OF KS ADULT SUPERVISORS

As the adult responsible for the group, you have the responsibility of ensuring that studentsare safe and are adequately supervised for the duration of the trip. You are alsoresponsible for ensuring that chaperones are fulfilling their responsibilities in seeing thatall students are safe.

Discipline Issues: Any discipline issues should be handled by KS adult supervisors and/oradministrators. Serious infractions should be reported immediately to an administratortraveling with the group or immediately upon return. Obtain written statements from allinvolved.

Medical Emergencies: The KS adult supervisor(s) should have medical information foreach student traveling with the group at all times. By completing the medical kit form inthe permission form packet, Hale Ola will provide you medical information for each

student traveling in your group. Contact parents if the situation warrants.Student Information: Chaperones must carry with them, at all times, each of theirstudents medical information and parent contact information.

General Expectations: While traveling with the group, it is prohibited to consume alcoholfor the duration of the trip. Any incidents involving you and students should be reportedimmediately upon return from your trip. Upon return, please submit all permission forms,incident reports, etc. to the Akahi Student Center. Records of the trip will be stored forseven years.

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KAMEHAMEHA SCHOOLS KAPLAMA HIGH SCHOOLFIELD TRIP AND TRAVEL REQUEST FORM

DATE: ___________________

NAME OF TEACHER: ______________________________ GROUP _____________________________________

TRAVEL DATE(S): ________________________# OF STUDENTS: _________ # OF CHAPERONES: __________PLACE OF EVENT: ______________________________________________________________________________

HOW DOES EVENT RELATE SCHOOL PROGRAM/SCHOOL GOALS:________________________________________________________________________________________________

________________________________________________________________________________________________

IF OTHER THAN EVENING OR WEEKENDS, JUSTIFICATION FOR GOING DURING SCHOOL HOURS:

________________________________________________________________________________________________

________________________________________________________________________________________________

IF EVENT WILL OCCUR DURING NORMAL SCHOOL HOURS AND/OR IS PART OF CLASSCURRICULUM :

Time students to be excused: _______ AM/PM Time to return: _______AM/PM

Periods students will be missing (Circle each one) HR 1 2 3 4 5 6 7 8 9 NONE(Please be sure to check black & white calendar for bell schedule)

Alternate activity for non-participating students: ________________________________________________________

Classes teacher will be miss attending event (Circle each one) HR 1 2 3 4 5 6 7 8 9 NONE

How will classes be covered: _______________________________________________________________________

Event contact person: ________________________________________ Event Phone #: ________________________

PLEASE ATTACH LESSON PLAN AND OBJECTIVES, FOUR (4) COPIES OF YOUR GROUP ROSTER(NAMES AND ID NUMBERS), TRANSPORTATION & FOOD SERVICE FORMS (IF NECESSARY) TO YOURDEPARTMENT HEAD.

DISTRIBUTION1. Copy w/ class list (DH) 2. Copy w/ class list (Unit 11/12) 3. Copy w/ class list (Unit 9/10) 4. Copy (ASC)------------------------------------------------------------------------------------------------------------------------------------------------------------------IF EVENT IS TO OCCUR OFF-ISLAND (any off-island travel at ANY time):

PLEASE ATTACH 5 COPIES OF YOUR GROUP ROSTER (NAMES AND ID NUMBERS) TRAVELITINERARY,COMPLETED PERMISSION FORM TEMPLATE AND EMERGENCY CONTACT INFORMATIONFOR DISTRIBUTION TO YOUR DEPARTMENT HEAD, UNIT VPs, BOARDING OFFICE AND PRINCIPALSOFFICE.

I certify that the financial obligations for this group are current.

_____ Approve _____Disapprove Comments:

__________________________________Dean of Student Activities Date

DISTRIBUTION:1. Copy w/ class list, itinerary, emerg. contact (DH) 2. Copy w/ class list, itinerary, emerg. contact (Unit 11/12)3. Copy w/ class list, itinerary, emerg. contact (Unit 9/10) 4. Copy (ASC) 5. Copy w/ class list, i tinerary, emergencycontact (Boarding) 6. Copy w/ class list, itinerary, emergency contact (Principals Office)

I certify that I have attached all required documents and I have cleared any financial obligations related to mygroup (if applicable).

__________________________________Advisors Signature Date


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FORM A

Other siblings at KS:Name/Gr ___________________Name/Gr ___________________

TB read date: __________CB clr date: ___________

Parent Volunteer Application forKHS- Kaplama Campus

KAMEHAMEHA SCHOOLApplication to Volunteer Kaplama Campus 2010-2011

Personal Information

Name (Print: Last, First, Middle): _______________________________________________________________Home address: _______________________________________________________________ Apt. #_________City: __________________________ State: _____________________ Zip Code: ________________________Home Phone: _______________________________ Work Phone: __________________________Students Name: _____________________________ Relationship: (to student) __________________________Grade: ______ Activities wishing to volunteer for : ______________________________________ ALL ________

Emergency Contact Information

Primary Contact Name (Print): __________________________________Relationship:________________________Address: _____________________________________________________________________ Apt. #________City: _____________________________ State: _____________________ Zip Code: ________________________Home Phone: _____________________________ Work Phone: _______________________________________

Secondary Contact Name (Print): _______________________________ Relationship: _____________________Address: ______________________________________________________________________ Apt. #_______City: _____________________________ State: _____________________ Zip Code: _____________________Home Phone: ___________________________ Work Phone: ________________________________________Name of Physician to be Notified: ___________________________________ Phone: ____________________

Confidentiality PledgeI agree that in conjunction with my volunteering any and all information obtained by me or disclosed to me during my service at KSwhich includes information not generally known to the general public or other departments within KS are strictly confidential andproprietary to KS and shall be treated as confidential information. I covenant in perpetuity that such information shall not bedisclosed, discussed or revealed to any persons, entities or organizations. I understand and acknowledge this Confidentialityprovision is a mandatory condition for KS to permit me to participate as a volunteer. I agree that KS would suffer irreparable harmif I breach this Confidentiality Pledge and therefore both parties agree that if such breach occurs, my service shall immediatelyterminate, and KS may take further appropriate action.

Statement of Understanding/Approval SignatureI hereby certify that the above information is true and correct and that the Kamehameha Schools may rely upon and release any suchinformation they deem advisable under the circumstances. I assume all risks of injury, damage or loss I sustain while I am on KSspremises or while I am participating in any KS program or service arising out of any cause whatsoever, and I hereby waive, release,and discharge KS of liability for such injury, damage or loss.

Authorization to Conduct Criminal History Record Check and Statement of UnderstandingI authorize Kamehameha Schools to conduct a criminal history record check, which may include fingerprinting, in accordance withthe procedures specified under section 302C-1 and 378-3 of the Hawaii Revised Statutes, to determine my suitability for working inclose proximity to children. I understand that if Kamehameha Schools finds by reason of the nature and circumstances of such

crime(s), if any, that I pose a risk to the health, safety, or well-being of children Kamehameha Schools may refuse to consider me asa volunteer. I hereby agree to release, indemnify and defend Kamehameha Schools, its trustees and employees, from all liability forany damage whatsoever that may arise from my disclosing this information. I swear under penalty of perjury that the above is trueand correct.(X) Volunteers Signature ___________________________________________________________Date _______________Soc. Sec. # (required) ________________________________________ Birth date: _________________________****SSN # REQUIRED FOR THE SOLE PURPOSE OF CONDUCTING A CRIMINAL BACKGROUND CHECK and WILL NOT BE PUBLISHED.

KS Approval Signature : ________________________________________________________Date: _________________Send completed application along with the TB questionnaire or TB clearance to:

Parent & Alumni Relations, ATTEN: Parent Volunteer Coordinator, 1887 Makuakne St, Honolulu, HI 96817


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Form B

RETURNING KS VOLUNTEER TUBERCULOSIS SCREENING QUESTIONNAIREThis form is mandatory and must be submitted with your volunteer application yearly

Thank you for applying to volunteer at KS for another year. For the safety of our students,please complete this Tuberculosis Screening Questionnaire to determine if you will need to havea NEW TB test done this school year.

Check One

QUESTIONS NO YES

1. Since your last TB Skin Test results were submitted to KS, have you had a newPOSITIVE TB Skin Test?

*** If YES, PLEASE ASK YOUR DOCTOR TO COMPLETE THE REST OF BOX #1:***

Date PPD Given:____________ Date PPD Read:___________ PPD Results:__________

Date Chest Xray Done:_______________ Chest Xray Results: ______________________

Physicians Name:___________________Physicians Signature:_____________________

2. Has a FAMILY MEMBER or a CLOSE CONTACT had a POSITIVE TB Skin TestOR Tuberculosis disease since your last TB Skin Test results were submitted to KS?

3. Have you traveled to any high-risk tuberculosis areas like: Africa, Asia, Eastern Europe,Central America, South America, Mexico, Caribbean, Japan, Philippines or the MiddleEast for more than one week since your last TB Skin Test results were submitted to KS?

4. Has anyone living in your household come to the US from a high-risk tuberculosis arealike: Africa, Asia, Eastern Europe, Central America, South America, Mexico,Caribbean, Japan, Philippines, or the Middle East in the past 5 years?

5. Have you worked or volunteered in a correctional facility, nursing home, homelessshelter, healthcare facility, hospital, police department, fire department or with an

Emergency Response Team since your last TB Skin Test results were submitted to KS?

If you responded NO to all of the above, please submit this questionnaire with your volunteer application.

If you responded YES to Question #1, take this form to your physician to complete the rest of Box #1before submitting this form with your volunteer application.

If you responded YES to Question #2, #3, #4, OR #5, take this form to your physician to have a NEW TBSkin Test done and documented below before submitting this form with your volunteer application.

PPD SKIN TEST(To be completed by your Physician or certified RN or taken to Hale Ola or Elem/Middle Medical Services Dept)

Volunteer Name ________________________________________________Birth Date________________

Date PPD given ______________ Time: _________ Site: right / left forearm. Administered by _________

Date PPD Read: ______________ Results: _______ mm Induration Read by: ___________________

If PPD is Positive, Please document Chest X-ray Date ____________ Chest X-ray Results ______________

Revised 6/16/09 White copy to Parent-Parent to forward to PAR Yellow copy-Hale Ola69


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field trip guidelines and fundraising and travel guidelines 2010 -2011

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