_______________________________________

AVIZAT,
Director,

(unitatea de nvmnt)

_______________________________________
(localitatea, judeul)
telefon ______________________________________________________

Nr. nreg. __________________________________

L.S.
data ___________

Ctre
_____________________________

1.
2.
3.

V rugm s aprobai deplasarea/excursia/tabra de studii/agrement/tematic/concurs/festival____

efectuat cu un numr de ___ elevi din clasele _________, i un numr de ____ cadre didactice nsoitoare.
Itinerar: _____________________________________________________________________________________
____________________________________________________________________________________________
Perioada ___________________________________ Durata excursiei: _______ zile,
L Ma Mi J V S D

iniial / reprogramat pentru_________din motive _________________________________________

____________________________________________________________________________________________
4. Obiective vizate: ______________________________________________________________________________
____________________________________________________________________________________________
5. Programul excursiei:
Ziua
Activitate n localitatea
Orele
Activitate n localitatea
Orele
Plecarea din localitatea
Sosirea napoi n localitatea
Mijloace de transport: __________________________________________________________________________
asigurate de __________________________________________________________________________________
7. Colectivul care rspunde de organizarea excursiei:
- cadre didactice nsoitoare care rspund de securitatea elevilor: Subsemnaii, nsoitori ai elevilor n aceast
excursie, declarm pe propria rspundere c vom asigura securitatea i integritatea elevilor participani. Am efectuat
instruirea elevilor, prezentndu-le normele de comportament civilizat i cele pentru asigurarea integritii lor fizice:
Semntura
1. _________________________________________________ (conductor) __________________________
2. ______________________________________________________________________________________
3. ______________________________________________________________________________________
4. ______________________________________________________________________________________
5. ______________________________________________________________________________________
8. Ali aduli nsoitori (prini, rude, etc.)
1. ______________________________________________________________________________________
2. ______________________________________________________________________________________
3. ______________________________________________________________________________________
9. Instructajul elevilor privind securitatea deplasrii s-a fcut la data de _________ i se va repeta nainte de plecare
de ctre _____________________________________________________________________________________
10. Organizarea programului de recuperare a orelor absentate

este excursia anual cu elevii claselor primare, nu necesit program de recuperare

excursia este organizat n zile nelucrtoare/vacan, nu necesit program de recuperare

elevii participani individual se angajeaz s recupereze n ritm propriu temele predate n orele de la care au
absentat

ntruct deplasarea se efectueaz n timpul programului colar, recuperarea orelor, pentru profesori i elevi, se
va face n felul urmtor: _______________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
11. Alte meniuni cu privire la organizarea i desfurarea excursiei:

costurile excursiei sunt suportate de prini I..J. M.Ed.C. consiliul local
sponsorul
________________________________________________________________________________________

grupul are n dotare trusa obligatorie de prim-ajutor / este nsoit de cadrul medical ___________________

cazarea este asigurat la____________________________________________________________________
6.

CONDUCTOR EXCURSIE,
____________________
L.S.

_______________________________________
(unitatea de nvmnt)

_______________________________________
(localitatea, judeul)

Nr. nreg. ____________________

TABEL NOMINAL
cuprinznd participanii la deplasarea/excursia/tabra de studii/agrement/tematic/concurs/festival/_______
din perioada ___________________, pe traseul _______________________________________________
_______________________________________________________________________________________
Subsemnaii, declarm c am luat la cunotin regulile de comportare i securitate privind
deplasarea n excursiile i taberele colare i ne angajm s le respectm ntocmai.
NUMELE I
SEMNTURA
CLASA
NUMELE I
SEMNTURA
CLASA
NR.
NR.
PRENUMELE
PRENUMELE
ELEV/PRINTE /OBS.
ELEV/PRINTE /OBS.
1.
31.
2.

32.

3.

33.

4.

34.

5.

35.

6.

36.

7.

37.

8.

38.

9.

39.

10.

40.

11.

41.

12.

42.

13.

43.

14.

44.

15.

45.

16.

46.

17.

47.

18.

48.

19.

49.

20.

50.

21.

51.

22.

52.

23.

53.

24.

54.

25.

55.

26.

56.

27.

57.

28.

58.

29.

59.

30.

60.
DIRECTOR,
____________________________

L.S.

CONDUCTORUL EXCURSIEI:____________________________SEMNAT__
CADRE DIDACTICE NSOITOARE:________________________SEMNAT_
____________________________________________________SEMNAT__
____________________________________________________SEMNAT__