FIELD TRIP/BUS REQUEST FORM

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Important: If field trip/bus request is for overnight travel or out of state, the field trip/bus request must be approved by the school board. Please allow additional time for approval.

NOTICE - A SEATING CHART IS REQUIRED!! The seating chart must be filled out before the trip!

I have read this and will fill out a seating chart before the actual trip takes place *

Yes

Teacher or Person Requesting: *

Destination: *

Exact Address of Destination: *

Additional Requested Stops: *

Request Date: *

YYYY

Trip Date: *

YYYY

Grade Levels that will be gone for Lunch (K-8): *

Will Transportation be Needed? *

YES

Total Number of People Transported: *

Number of Buses Needed: *

Type of Buses Needed: *

Place of Departure or Door Number: *

Departure Date & Time: *

Return Date & Time: *

Teacher(s) Complete Names: *

Estimated Costs to Individual Students:

To be Paid By:

Purpose of Trip:

State the educational goals/objectives that are to be met for each student:

State the number of regular instructional minutes that will be lost for each student:

I have utilized the guidelines in 2340A to plan, conduct, and evaluate the trip and, upon approval of the trip, I will obtain parental permission and use the trip checklist.

The staff member in charge will have a COMPLETED EMERGENCY MEDICAL FORM for each student on the trip.

If field trip/bus request gets cancelled, I will notify the Principal and Transportation Director as soon as possible. Failure to notify of cancellation or changes may result in a fee to the building or organization.

@ NEOLA 2010 - FORM 2340 F1 & F4

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