Field Trip Request Form
This Field Trip Request Form must be submitted to Mr. Jim Cartnal / Dr. Jarrett Gold for approval by Department Chairs.
Teacher Name *
Class *
Trip Date *
MM
/
DD
/
YYYY
Destination *
Nature of Educational Experience *
Address *
Phone Number *
No. of Pupils *
No. of Adults *
Students will be gone during periods (check all that apply) *
Required
Names of all Chaperones *
Student Roster Link (via Google Docs) *
Trip Funding Source *
Substitute need during trip? *
Sub Periods *
What form of transportation will be used? *
Bus Estimated Cost
Bus Arrival at LCHS
Bus Return at LCHS
If you are using private cars, have you completed the Driver Insurance Forms? *
Specify other transportation options
Submit
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