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Field Trip Request Form
This Field Trip Request Form must be submitted to Mr. Jim Cartnal / Dr. Jarrett Gold for approval by Department Chairs.
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* Indicates required question
Teacher Name
*
Your answer
Class
*
Your answer
Trip Date
*
MM
/
DD
/
YYYY
Destination
*
Your answer
Nature of Educational Experience
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
No. of Pupils
*
Your answer
No. of Adults
*
Your answer
Students will be gone during periods (check all that apply)
*
All Day
Period 1
Period 2
Period 3
Period 4
Period 5
Period 6
Required
Names of all Chaperones
*
Your answer
Student Roster Link (via Google Docs)
*
Your answer
Trip Funding Source
*
Choose
ASB
Field Trip
District
Other
Substitute need during trip?
*
Yes
No
Sub Periods
*
Half Day
Full Day
What form of transportation will be used?
*
Bus
Private Cars
Other:
Bus Estimated Cost
Your answer
Bus Arrival at LCHS
Your answer
Bus Return at LCHS
Your answer
If you are using private cars, have you completed the Driver Insurance Forms?
*
Yes
No (See Claudia)
Specify other transportation options
Your answer
Submit
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