FIELD TRIP AUTHORIZATION

SECTION 1 – MANDATORY INFORMATION

WHAT MODE OF TRANSPORTATION WILL YOU BE USING? Check one of the following:

DISTRICT BUS CHARTER BUS DISTRICT VAN RENTAL VAN WALKING

Other, please specify: ________________________________________________________________________

PLEASE NOTE: VANS ARE ONLY TO BE USED FOR TRIPS INVOLVING NINE (9) OR LESS STUDENTS

(See Over for More Information)

School Name of Student Group______________________ Number of Students Involved

Departure DATE______________ Departure TIME Return DATE_____________ Return TIME

Destination________________________________________ Purpose of Trip

Will a Substitute Teacher be Needed? Yes No If Yes, for what period(s)

Parent Permission Forms will be Completed and On File at School? Yes (Required for ALL Field Trips)

Field Trip Checklist Attached? Yes (Required for ALL Field Trips) Is field trip extra-curricular? Yes No

BUDGET CODE __________________________________________________________

NAME OF TEACHER REQUESTING TRIP (Please Print) Date

PRINCIPAL’S SIGNATURE Date

SECTION 2 – DISTRICT VAN or RENTAL VEHICLE (If Applicable)

Using Rental Van? Yes No If yes, Budget Rental’s Reservation Number _________________________

Using District Van? Yes No If yes, what is the District Vehicle Number __________________________

Person Picking Up Vehicle _________________________ Name of Person to Contact for Questions

When will theVan(s) be picked up? DAY OF TRIP at (Time)____________ OR DAY BEFORE at (Time)

Volunteer Driving: Volunteer Driver Checklist (Form 8131F) is on file at school? Yes (REQUIRED)

Teacher Driving: Assurance Statement for Employees (Form 8132F) is on file at school? Yes (REQUIRED)

SECTION 3 – ADMINISTRATION OFFICE

YES, Request is Approved NO, Request is NOT Approved

If not approved, reason___________________________________________________________________________

DISTRICT ADMINISTRATOR SIGNATURE ____________________________________ Date ____________

SECTION 4 – TRANSPORTATION OFFICE

Driver Assigned___________________________ Date of Trip______________ Bus Number Assigned__________

(Departure Time*___________) Return Time__________ (Miles Round Trip*__________) Cost_______________

Total Hours Regular Pay__________ Hours Overtime__________ Benefits__________ Driver Meal____________

(*TO BE COMPLETED BY THE DRIVER) TOTAL COST____________________________

TRANSPORTATION SUPERVISOR SIGNATURE ________________________________ Date____________