Field Trip Request Form - For Building Use Only printable pdf download

Field Trip Request Form

For building use only

*For the purpose of policy, a field trip is defined as a planned journey by one or more students away

from premises, which is an integral part of a course of study and is under the direct

supervision and control of a professional (Licensed) staff member or other advisor as designated by

the superintendent.

Teacher:____________________________________ Class/Grade:_____________________________

Date of Trip:______________________________ Request Date:____________________________

Event:______________________________________ Location:_________________________________

Number of Students:____________ Number of Staff/Chaperones:__________________

Cost to Student:__________________ Funded by:_______________________________________

Means of Transportation:_______________________________________________________________

Provisions:

1. The principal must sign this form at least one month in advance of the

proposed field trip.

2. Teacher/advisor must obtain all applicable permission/release forms from

each participant prior to leaving the school district for the event. A copy of

each student’s Emergency Medical Form must be in the possession of the trip

supervisor throughout the duration of the trip.

This field trip is part of the following unit : ____________________________________

This field trip will help students answer the following essential question(s) and/or follow

the listed NCSCS Objectives:

_________________________________________________________________________________________________

Staff Member:______________________________________________________ Date:________________________________

Principal:___________________________________________________________ Date:________________________________

PLEASE COMPLETE THE FOLLOWING CHECKLIST PRIOR TO TURNING THE FORM TO THE

BUILDING PRINCIPAL ONE MONTH PRIOR TO THE DAY OF YOUR PROPOSED FIELD TRIP.

__________ 1. I have scheduled any necessary transportation for the proposed trip through the

main office.

__________ 2. I have informed the building administration, and all special area teachers of the

scheduled trip well in advance.

__________ 3. I have provided permission slips for parents/guardians well in advance. A copy

of the permission slip has been given to the principal.

__________ 4. I am aware that a copy of each student’s Emergency Medical form must be in my

possession or the possession of another supervising teacher throughout the

field trip.

__________ 5. I understand that students may not be transported in private vehicles without

the approval of the building principal and the superintendent.

___________________________________________________________________ __________________________________

Teacher Signature:

Date:

Administrative Decision

_____Approved

_____Disapproved

Signature ___________________________________________________________________________

Field Trip Request Form - For Building Use Only

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