To be completed by the teacher contact for this trip.
Description of trip, program, workshop, etc.:
Name of ONE teacher contact for this trip:
Email for the contact teacher:
Class or classes attending trip:
Total number of students attending trip:
All school staff attending trip:
Number of chaperones needed for trip (1:10 ratio for general ed. & 1:5 ratio for special ed. as per DOE mandate):
Unit cost for trip (price per student or price per group): $
Total cost per trip: $
Who is paying the cost of this trip:
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