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 #___________
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)
Involving Swimming or Wading
Educational nature of field trip/excursion__________________________________________________________________
TRANSPORTATION will be provided by:
School Bus - contact Transportation Field Trip Office
Charter Bus Company (certified):
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)
Funding Source____________________________________ Financial Assistance Available?
Number of students participating: ___________________
Teachers and Staff Attending:
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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