Application for Approval by Lancashire County Council

FORM 1 - B

Type ‘B’ Visits

APPLICATION FOR APPROVAL BY LANCASHIRE COUNTY COUNCIL

FOR SCHOOLS AND YOUNG PEOPLE’S SERVICE GROUPS

TO UNDERTAKE AN ACTIVITY/ EXPEDITION/ RESIDENTIAL/ EXCHANGE VISIT

To be submittedAT LEAST 6 weeks prior to the event taking place (NB 6 months for visits outside the UK)).

(Please see Section G of this Form: ‘Notes’)

APPLICATION FOR PROPOSED VISIT TO:

A. SCHOOL / YOUTH GROUP DETAILS:
Name of School/ Youth Group: / Dist/ Sch No:
Address of School/ Youth Group:
Tel No (please include the code): / ( )
School / EVC email address:
Is this a cluster visit? / YES / NO
If ‘YES’, please state which schools are in the cluster:
B. ACTIVITY & STAFFING DETAILS:
Purpose of visit and specific Educational Objectives:
1.
2.
3.
Details of the Programme of Activities:
1.
2.
3.
Places to be visited:
Type of Activity:
Alternative Planned activity (Plan B):
(NB this must be included in the Risk Assessment)
Date of Departure: / Time of Departure:
Date of Return: / Time of Return:
Has a Pre-visit been undertaken? YES / NO / Date undertaken:
Date of intended pre-visit:
Name of Provider of Activity:
Address of Provider:
Telephone No: / ( ) / Licence No (if AALA registered):
Proposed cost and financial arrangements:
Does this comply with the school’s charging policy?(please see Appendix 6)YES /NO
Insurance Arrangements for all members of the proposed party, including voluntary helpers:
Insurance Company: / Tel No: / ( )
Address:
Insurance Cover: / Policy No:
Size & Composition of Group:
AgeRange: / No of Boys: / No. of Girls:
Are there any pupils with SEN, Medical Needs or Disabilities? / YES / NO
N.B. If ‘YES’, this should be specifically referred to in the Risk Assessment and any necessary adjustments made to the programme of activities. (Reference Appendix 18)
Adult to Pupil Ratio: / (Please Check Ratios in the Educational Visits Policy – Section 3.2)
Details of Staffing:
Name of Visit Leader: / Mobile Tel No:
Email address:
Name of First Aider(s):
Indicate if any staff/volunteers have children taking part on the visit / Male
(Enter Number) / Female
(Enter Number)
Numbers of Teaching Staff:
Number of Youth Workers
Teaching Assistants / Support Staff:
Governors:
Parents:
Others (please specify)

NOTE:

1. If any of the above staff/ volunteers have children taking part on the visit please refer to the Educational Visits Policy, Section 3.2.1.

2. Please ensure that the Visit Leader is included in the staffing list above.

Name and details of any accompanying LCC Registered Instructors involved in this visit: / LCC Registration No:
Provider of transport:
The transport arrangements are: / Hire / LCC / Own Vehicle* (Please refer to the Policy and Appendix 5)
Please give details of transport arrangements:
C. HEALTH & SAFETY:
Intended date of briefing to pupils /
young people: / Date: / Intended date of parental /
carer briefing: / Date:
Intended date parental / carer consent will be obtained by: / Date: / Intended date medical information provided:
(NB this applies to all pupils and adults) / Date:
Name of Emergency Base Contact Person:
Daytime Telephone No:
Out of Hours Tel: No (NB this can be a mobile number): / ( )
( )
Please confirm that the Base Contact is NOT taking part in the visit/activity
Signature of the Visit Leader:
NOTE: The Base Contact MUST:
not be part of the visit / activity,
be contactable until the visit/activity is deemed closed,
be in possession of all details from this Form 1B and
have all the participants (including staff and volunteers) names, addresses and telephone numbers and emergency contact numbers etc. (Please refer to Form 9).
Contact details in the event of a major incident:
Name and contact details of designated Senior Staff:
(NB these can be a mobile numbers) / Name
In hours tel no:
Out of hours tel no: / 
( )
( )
Name
In hours tel no:
Out of hours tel no: / 
( )
( )
D. RESIDENTIAL DETAILS:
Centre/ Base/ Campsite: / Head of Centre Name:
(If more than one camp site/ base, list them and provide the telephone numbers)
Address:
Telephone No: / ( )
E. SECONDARY AGED PUPILS AND YOUNG PEOPLE’S SERVICE ONLY (IF APPLICABLE)
DUKE OF EDINBURGH SECTIONAL ACTIVITIES
State the alternative activities (Plan B):
Location/ Route:
Activity Programme Prepared? ` / YES / NO / Wild Country Panel informed?
Route Card Prepared? / YES / NO / Route Card Lodged with?
Instructor carrying a mobile phone? / YES / NO / Mobile No.:
Group carrying a mobile phone? / YES / NO / Mobile No:
All activities must be approved, by the appropriate signatories

State the date that this Visit was approved by the Governing Body: ……….………………………………….

I confirm that all the staff /adults on the visit/ activity have read, understood and adopted the written risk assessment.

Signature of Visit Leader: …………………………………………… Date: ……………………………..……………

If this application is late (see notes below), please give the reasons for the delay: ……………………….....

…………………………………………………………………………………………………………………………………

Is this a late application by negotiation with the Technical Adviser? YES / NO

THIS SECTION MUST BE SIGNED PRIOR TO SUBMISSION TO THE AUTHORITY
Signed:……………………………………………………………………………………………………………………
Headteacher/EVC/Young People’s Service Operations Manager
Print Name …………………………………………………………….……………… Date: ……………………………
G. NOTES

A copy of all forms should be retained by the School/ Young People’s Service.
Forms should be submitted to the Authority AT LEAST 6 WEEKS prior to the event taking place.
For visits abroad, the Forms should be submitted to the Authority 6 MONTHS prior to the event taking place.
Late applications will only be considered by the Authority in very exceptional circumstances. Any late application should be negotiated with the Technical Adviser.

N.B. There is no guarantee that approval would be given to late submissions.

All late applications will be reported to the School’s Governing Body on an annual basis.
A separate form should be submitted for each activity.
Form 1B should be forwarded, together with a copy of the Risk Assessment (Form 5), to:

Educational Visits Team, PO Box 61, County Hall, Preston, PR1 8RJ
PLEASE ENSURE THAT ALL PAGES ARE COMPLETED BEFORE
SUBMITTING FORMS 1B AND 5 TO THE AUTHORITY FOR APPROVAL
NB: FORM 5 (RISK ASSESSMENT) MUST INCLUDE THE ALTERNATIVE PLANNED ACTIVITY

Form 1B Application Form Type B Visits (revised June 2008)