Trip Ticket
To be completed by the teacher contact for this trip.
Name *
Your answer
Grade: *
Trip Destination: *
Your answer
Trip Date *
MM
/
DD
/
YYYY
Description of trip, program, workshop, etc.:
Your answer
Name of ONE teacher contact for this trip:
Your answer
Email for the contact teacher:
Your answer
Class or classes attending trip:
Your answer
Total number of students attending trip:
Your answer
All school staff attending trip:
Your answer
Number of chaperones needed for trip (1:10 ratio for general ed. & 1:5 ratio for special ed. as per DOE mandate):
Your answer
Transportation:
Unit cost for trip (price per student or price per group): $
Your answer
Total cost per trip: $
Your answer
Who is paying the cost of this trip:
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This form was created inside of PS 191 - The Riverside School for Makers and Artists.