Special Services Field Trip Request Form 2019-2020
This form is to be utilized when requesting a field trip. Large buses fit 42 passengers, white van fits 9 passengers. Each wheel chair means 6 less passengers.
Email address *
District *
Site *
Staff Requesting Trip *
Your answer
Program *
Your answer
Date of trip *
MM
/
DD
/
YYYY
Destination(s) (include if there is a lunch stop planned) *
Your answer
Address of Destination(s) (include if there is a lunch stop planned) *
Your answer
Phone Number of Destination *
Your answer
Pick up Location (What door or entrance, i.e. main, gym, etc) *
Your answer
Number of students *
Your answer
Number of staff (Name of staff in charge and cell phone number) *
Your answer
Configuration (Any wheel chairs, car seats or harnesses) If so how many? *
Your answer
Departure Time (When does the bus need to be at your school) *
Time
:
Return time (When does the bus need to be back at your school) *
Time
:
Is there a parking fee for the bus? How much? *
Your answer
Cost per student *
Your answer
Cost per staff *
Your answer
Total Cost *
Your answer
Purpose of the trip (Educational Objectives) *
Your answer
Do not fill out below this area: (Administrators only)
Principal's Approval
Superintendent's Approval
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