Form Rsk -F106a - Field Trip Request Form - Sacramento City Unified School District

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Sacramento City Unified School District

FIELD TRIP REQUEST FORM

(USE A SEPARATE FORM FOR EACH TRIP)

Parent Permission Form is required for each student field trip. See below reference distribution section for details concerning each type of trip.

School Name__________________________________________________ Date__________/___________/___________

Teacher's Name______________________________________________Room #____________Telephone #___________

Fax #________________

Field Trip Destination_________________________________________________________________________________

 Local-50 mile radius (bus/walking)  Local-50 mile radius (driver led trips)

 Out-of-Town (Beyond 50 mile radius)

(forward directly to Field Trip Office)

 Overnight

 Out-of-State/Country

 Involving Swimming or Wading

 Unusual Activities

Route_____________________________________________________________________________________________

Educational nature of field trip/excursion__________________________________________________________________

__________________________________________________________________________________________________

Depart Date_____/_____/_____Time_______am/pm

Return Date_____/_____/_____Time________am/pm

TRANSPORTATION will be provided by:

 Walking

 School Bus - contact Transportation Field Trip Office

 Charter Bus Company (certified):

 Yes

 No - Check with Field Trip Office

 Private Vehicle/Parent Driver/Faculty Driver - Complete Volunteer Personal Automobile Use Form for each vehicle

and driver, must have fingerprint clearance (check with Human Resources for fingerprint clearances)

 Public Transportation

 Train

 Commercial Airline

 Other:______________________

Funding Source____________________________________ Financial Assistance Available?

 Yes

 No

Number of students participating: ___________________

Adult Chaperones/Drivers:

DRIVER

1)______________________________  yes

 no

2)______________________________  yes

 no

3)______________________________  yes

 no

4)______________________________  yes

 no

Teachers and Staff Attending:

1)____________________________  yes

 no

2)____________________________  yes

 no

3)____________________________  yes

 no

4)____________________________  yes

 no

Principal Approval ________________________________________________ Date______________________

Risk Management Approval (Unusual Activities) ________________________ Date______________________

Segment Administrator Approval ___________________________________ Date______________________

Distribution: Refer to the Field Trip Information Form RSK 106F for the forms and distribution required for each trip:

Local Trip (school or charter bus): (50-mile radius) - Submit to Principal for approval. Maintain all documents at site and forward a copy to Segment Administrator.

Local Trip: (50-mile radius: driver led, walking trip) – Submit driver led trips to Principal for approval then forward to Segment Administrator for approval 6 weeks prior to trip. Submit

walking trips to Principal for approval then forward to Segment Administrator for approval 2 weeks prior to trip.

Out-of-Town: (beyond 50-mile radius) – Submit to Principal for approval then forward to Segment Administrator for approval 6 weeks prior to trip.

Overnight Trip: Submit to Principal for approval then forward to Segment Administrator for approval 6 weeks prior to trip.

Trip Involving Swimming or Wading: Submit to Principal for approval then forward to Segment Administrator for approval 6 weeks prior to trip.

Trip Involving Unusual Activities (Water sports or high risk activities such as rafting, snorkeling, rock climbing, skiing, etc.) - Submit to Principal for approval then forward to

Segment Administrator for approval 6 weeks prior to trip. This may require Special Event Liability Insurance.

Out-of-State/Country: Submit to Principal for approval then forward to Segment Administrator for approval 6 weeks prior to trip. Must have Superintendent, Board of Education and

Risk Management approval prior to trip. Segment Administrator will place field trip item on Board Agenda. Trips not submitted to Segment Administrator 6 weeks prior to trip will be

considered automatically rejected by the Board of Education.

Approved forms will be returned by Segment Administrator. Maintain a copy of all forms at site for 2 years.

7/28/17 Rev C

Field Trip Request Form RSK-F106A

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