Transportation/Trip Request
Please complete and submit this form at least two weeks in advance of your request.
Upon submission, your form will automatically be emailed to your supervisor for approval, and then on to Marion School District Transportation Coordinator Scott Arndt.
Email address *
Your Supervisor's Email Address *
Person/Department Responsible for the Trip *
Your answer
Destination with address *
Your answer
Type of Activity *
Trip Date *
MM
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Grade Level *
Your answer
Number of Students *
Your answer
Number of Adults *
Your answer
Place of Departure *
Departure Date & Time *
Very Important: MUST be before the return time!!
MM
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DD
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YYYY
Time
:
Return Date & Time *
Very Important: MUST be after the departure time!!
MM
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YYYY
Time
:
If driving, date the keys & gas card would be picked up
MM
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DD
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YYYY
Type of Vehicle *
How does the trip relate to the class activity? Explain pre- and post- activities planned to make use of the information gained from the trip. *
Your answer
List any students with known health concerns
Your answer
List and explain any special arrangements that are necessary, including student name, concern and provision.
Your answer
Do you need extra transportation for equipment? *
Are there any students needing medication? *
List the name and medical instructions for any students requiring medication or medical care.
Your answer
Are there any adults able to administer first aid or emergency care? *
List emergency help available at destination *
Your answer
Nearest Hospital/Emergency Medical Services *
Notes/Special Considerations
Your answer
By typing my name below and submitting this form this form, I agree to:
**Follow all state and federal driving laws when using a school vehicle checked out to me,
**Drive the school vehicle with care & caution,
**Fill the van with gas if the trip exceeds 15 miles,
**Remove any garbage and personal items left in the van by students or myself.
Electronic Signature *
Your answer
Signature Date *
MM
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YYYY
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