Field Trip Request Form printable pdf download

Field Trip Request Form

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

from the district 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/Chairperson:_______________

District Cost:______________________

Funded by:______________________________

Cost to Student:___________________

Funded by:______________________________

Means of Transportation:__________________________________________________________

Provisions:

1. The Director must sign this form at least three weeks 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 possession of the trip supervisor throughout the duration of the trip. The Nurse

Supervisor must also be contacted regarding medical needs for field trip.

This field trip is part of the following unit:______________________________________________

________________________________________________________________________________

This field trip will reinforce the following big idea:________________________________________

________________________________________________________________________________

This field trip will help students answer the following questions(s):__________________________

________________________________________________________________________________

Staff Member:______________________________

Date:_____________________________

Director/Multi-District Coordinator:____________

Date:_____________________________

Field Trip Request Form