IJOA-R Request for Educational Field Trip

REQUEST FOR EDUCATIONAL FIELD TRIP

At least two weeks before the proposed day of any field trip if transportation is involved, the teacher shall supply the following information to the principal in duplicate.

 

School: _____________    Grade:  _______________    Date: ____________

 

Teacher: ________________________________

 

Trip:_____________________________________________________________

 

Reason:__________________________________________________________

 

Date of Trip: ___________________       Estimated Miles: ________________

 

Bus or Private Vehicle: ______________________________________________

 

Departure Time: ___________________      Return by: __________________

 

Number of Pupils: ___________________     Number of Adults: ____________

 

 

Names of Chaperones (or see next page):  ________________________________________________________________

 

________________________________________________________________

 

Comments:  _____________________________________________________

 

________________________________________________________________

 

________________________________________________________________

 

________________________________________________________________

 

See Policy IJOA

CONTOOCOOK VALLEY SCHOOL DISTRICT
FIELD TRIP PROPOSAL

 

  1. Name: ______________________________________ Grade: ________________    School: _____________
  2. Number of students attending: ______________________ School Nurse Required: _________________
  3. Destination: ___________________________________________________________________________
  4. Reason for Trip (how does this trip relate to your curriculum)______________________________________

__________________________________________________________________________________

______________________________________________________________________________________

 

  1. Transportation: Bus or private vehicle  (circle one) – private vehicles will require completion of the Use of

Private Vehicle form

  1. Ratio of adults to students: ________________________ to_______________________

 

___________________________________________      __________________________________________

Staff Signature                            Date               Principal Signature                       Date

School Use Only:  All items listed below must be completed before the Principal (or designee) will sign:

  • Bus Form
  • Fee Paid by:
  • Chaperones identified (attach list)
  • Permission slips signed and attached
  • Attending student list to front office
  • Kitchen notified if lunch affected
  • Specialist/services notified
  • Posted on School Calendar
  • School Nurse Notified
  • CPR/First Aid Trained:  Name

For SAU Use:

School Board approval required for trips of more than two (2) days (refer to field trip policy IJOA).

Proposal forms must be submitted to the Principal by April 1, to the Superintendent by May and approved by the School Board no later than the August meeting for trips during the new school year

 

Date Received at SAU Office:  ______________

Date Approved/Not Approved by School Board: ______________  (for over-night or swimming trips only

(Please Circle One)

 

Superintendent/Board Chairman Signature__________________________________________________________