Field Trip Request Form printable pdf download

Ref: IJOA – Field Trips: Overnight and Foreign Travel

IJOAA – Field Trips: Eight Grade Year End Trip

MSAD #58

IJOAAA – Field Trips: Day Trips

FIELD TRIP REQUEST FORM

To be used for Day, Overnight, and Foreign Trips

THIS FORM MUST BE SUBMITTED TO THE CENTRAL OFFICE ONE (1) MONTH PRIOR TO A DAY TRIP

THIS FORM MUST BE SUBMITTED TO THE CENTRAL OFFICE ONE (1) MONTH PRIOR TO AN OVERNIGHT TRIP

THIS FORM MUST BE SUBMITTED TO THE CENTRAL OFFICE SIX (6) MONTHS PRIOR TO A FOREIGN TRIP

DATE:_____________________

1. Teacher(s):___________________________________________________________ School:______________________________

2. Grade(s):_________________ Number of Students:___________________________

3. Date of Visit:______________ Departure Time:______________________________ Return Time:_________________________

4. Destination and curriculum connection(s):_______________________________________________________________________

____________________________________________________________________________________________________________

All students must have prior, written parental permission to participate in any field trip. When the trip is a local walking trip with one

time, “blanket” permission being applied (i.e. monthly trips to the library) parents still must have advance notice of your plans,

including the date and time for each trip.

5. Number of volunteer chaperones, (per policy):__________

6. Cost to each student:________________________________________________________________________________________

Please indicate how funding will be provided for students who cannot afford the costs. Required field trips will be made available to all students.

Please initial #7 and #8 and #9 as N/A when item is not applicable.

7. _____Have you notified the cook if your class is going to be away during their scheduled lunch, and/or verified the number of bag

lunches that will be needed for the field trip?

8. _____Do you need to make arrangements to cover scheduled duties during your absence?

9. _____Have you submitted a bus request form?

10. ____Have you notified the nurse?

11. Who is the trained individual providing any student medications that need to be administered during the trip?

Name:____________________________________________Training:_______________________________________________

(Please be sure the parent is aware of this arrangement)

Nurse’s Signature:_________________________________________________________________________________________

12. Cell phone(s) to be taken on this trip: Name(s) and number(s)______________________________________________________

________________________________________________________________________________________________________

13. YOU MUST ATTACH A LIST OF VOLUNTEER CHAPERONES WHEN SUBMITTING THIS FORM

All volunteer chaperones will be required to have a satisfactory background check on file in the Superintendent’s Office.

Please attach completed and signed MSAD #58 Volunteer Chaperone Background Check forms to this request if one is not on

file. You may contact the District Office at 639-2086 ext 5289 if you have any questions.

Principal’s initials verifying all students have received and returned SIGNED permission slips:________

Teacher’s Signature:_______________________________________________________________Date:_______________________

Nurse’s Signature:_________________________________________________________________Date:_______________________

Cook’s Signature:_________________________________________________________________ Date:_______________________

Principal’s Signature - All policy requirements have been met:__________________________________________Date:___________

Superintendent’s Signature or Designee:____________________________________________________________Date:___________

Approved:___________

Denied:____________

IF YOU HAVE ANY QUESTIONS PLEASE SEE THE DISTRICT’S FIELD TRIP POLICIES

Field Trip Request Form

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