4-H Outdoor Education Trip Plan
DOWNLOADJune 3, 2025 - Michigan State University Extension
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EmailVolunteers should complete this form whenever they are planning a trip that includes overnights. Volunteers should submit this form to their 4-H Program Coordinator.
Trip Basics:
•Name of Active Gold Volunteer completing this form:
•Date(s) of trip:
•Location of trip:
•Total number of youth participants:
•Age range of youth participants:
•Names of Active Gold Volunteers attending trip:
*All parents/adults attending an overnight trip must be Active Gold Volunteers who have completed the 4-H Chaperone Module in Volunteer Central.
•Names of MSU Extension staff members attending trip, if any:
•All Active Gold Volunteers attending have completed the Volunteer Central Chaperone Training Module (required): Ο Yes Ο No
- Please provide a list of any relevant certifications that Active Gold volunteers or MSU Extension staff members currently hold (1st aid/CPR, Wilderness First Aid, etc.):
Transportation:
•Method of travel:
•Departure time/location:
•Lodging arrangements (tents, cabins, etc.):
•Return time/location:
Contact Information:
•Contact information for trip leaders during the trip:
•Name and number for relevant authorities in the area (DNR Warden, Sherriff, etc.):
•Name, number, and location of nearest hospital (preferably within 30 minutes of location)
Daily Schedule:
Provide a daily schedule for each day of the trip, including approximate times of each activity. Include how many miles you plan to travel, meals, wake up and bedtimes, and any other relevant information. For the first and last days of the trip, include where and how parents/guardians will drop off or pick up children. (Attach additional sheets if necessary).
Supporting Documents:
Ο Trip leaders have completed the General Outdoor Education Risk Management Checklist
Ο Trip leaders have completed the Risk Management Checklist specific to their activity (paddling, backpacking, etc.)
Ο Trip leaders have attached all supporting documents resulting from completing the checklists (float plans, permission slips, maps, etc.)
Ο Trip leaders have ensured that all youth participants attending are currently enrolled in 4-H Online and the club leader in charge of the trip has copies of health and medical release information for all youth and volunteers with them on the trip in case of any incident.
Ο Trip leaders have a sign-in/sign-out sheet that will indicate who will be picking up youth at the designated location at the end of the trip.
Review:
Trip Leader:
I verify that the information provided in this trip plan is accurate to the best of my knowledge and agree to follow all 4-H and MSU Extension policies while on this trip.
Signature:
Date:
MSU Extension Staff:
I have reviewed this Trip Plan and all supporting documents related to the trip.
Signature:
Date:
Support
For more information contact:
Dorothy Munn
Policy and Risk Management Educator
munnd@msu.edu
Joe Kreider
4-H Natural Resources and Outdoor Education
kreider4@msu.edu
Daily Schedule continued, if necessary: