Field Trip Notification Form Staff initiating Travel Request: • Please complete and submit this form along with attachments to Principal for Pre-Approval. • Please refer to the Field Trip Handbook for guidelines. • Once approved, the information will be given to the Secretary for processing. • Please include all information required for completion of a prior/contracts/requisitions. Itinerary (Attach trip details including location,
agenda and activities. If a Board Prior is required, please include information on how the trip supports the strategic direction of MSD.)
Staff Traveling
Volunteers/Chaperones (One district-approved adult chaperone must be in attendance on every trip for every 10 students. Please refer to Field Trip Handbook for guidelines.)
Will the trip meet this ratio? Yes ☐ No ☐
This trip requires a prior? Yes ☐ No ☐ Number of Students:
Trip requires Board Approval (min. 6 week notice)
Subs Required Yes ☐ No ☐
Parental Forms
Departure Date: Return Date:
Out of State Travel ☐
Overnight with students ☐
Pre-Approval: attach copy of completed permission slip After Approval: indicate date permission slips are sent home PRIOR to trip. Date: After Approval: Have medication forms for all students who will be taking prescription medication during the trip been collected? Yes ☐ No ☐
Account Code(s) for Funding* Code: Code: Code: Code:
Est. $$: Est. $$: Est. $$: Est. $$:
*ASB funds require approval prior to completion of prior.
Risk Management
Please consult with Risk Management when considering the following: 1. Student Driver(s); Parent(s) driving own student(s)**; Volunteer Driver(s)** 2.
**Follow the Volunteer Driver Clearance Procedure
Review of potential High Risk Factors.
Food Services
Pre-approval: ☐ # of teacher/adult sack lunches needed*: ☐ # of student sack lunches needed*: ☐ No lunches required. Total students off campus during lunch:
Cert ☐ Total # ____ Classified ☐ Total # ___ Sub Online Entry Staff ☐ Office ☐ District ☐
Time Event Starts: Time Leave Campus: Notes:
Trip/Event Purpose: Location:
End: Return:
Address:
Type of Transportation (Check all that apply) District Bus Charter Bus Rail Fair Charter Boat Airplane Other _______________ Number of Drivers needed: Trip Mileage: ☐ ☐ ☐ ☐ ☐ ☐
Cashier/Secretary
Is money being collected from students, parents, and/or chaperones? Yes ☐ No ☐
☐ District Van/Car ☐ Private Vehicle ☐ Rental Car ☐ Ferry ☐ Walking
If Yes: $_______per student $________per adult Funds being collected are for: Money is due to office no later than:
Be sure to include company name for transportation.
Note: Students must turn in their money to the building’s CASHIER/SECRETARY. Storing money overnight in classrooms is not allowed by state accounting guidelines!
Lodging
Approval
Notes:
Request Submitted by (NAME): Date: Phone:
Location Address
Est. Cost Staff: Est. Cost Students: Notes:
*After approval: Please provide a list of students/staff
attending to kitchen staff so they know the correct accounts to be charged.
Estimated Cost(s) for Meals Students: Staff: Notes:
Contact Information
For emergency purposes, please provide the cell phone number of two adults attending this field trip.
Are all chaperones currently cleared volunteers? Yes ☐ No ☐
Registration (if different than noted above in “Purpose”) Event/Conference Address
Est. Cost Staff: Est. Cost Students: Notes: Name: Position (staff/volunteer): Cell Phone: Name: Position (staff/volunteer): Cell Phone:
Reviewed by Principal (NAME): Date: Approved: Yes ☐ No ☐ If no, reason for denial: Reviewed by ASB (NAME): Date: Approved: Yes ☐ No ☐ If no, reason for denial:
Additional Notes
Office Use Only
Notification Form will be distributed to the following by the Secretary: ☐ Principal ☐ Assistant Principal ☐ Kitchen (sack lunches) ☐ Kitchen (NO lunches) ☐ Head/Assistant Secretary for FILE Copy
FTOE 1.0 Rev 1/2016
☐ Nurse/Health Room ☐ Kitchen (student list(s)) ☐ Add to Building Activities Calendar