File: IJOA-E
Gardner Public
Schools
Field Trip Approval Form
(This form must be
completed for all field trips and signed by the building principal before it is
forwarded to the Superintendent for approval.)
School__________________________________________________________________
Grade or
Class___________________________________________________________
Number of Students
Attending_____________________________________________
Destination______________________________________________________________
How does the trip
relate to the curriculum or to the school-sponsored or school-approved
extra-curricular activity (i.e., band, student council, and so on)?
Departure
date/time/place_________________________________________________
Return
date/time/place____________________________________________________
Transportation
Provider_______________________ Cost of Transportation_______
Cost of
Activity__________________________________________________________
How will the cost of
transportation and activity be paid? _______________________
Ratio of chaperones
to students_____________________________________________
Sample Parent
Permission Slip Attached: ______yes ______no
Emergency Phone Contact
List ______yes ______no
School
Nurse____________________________________ Date______________
Principal________________________________________ Date______________
Superintendent__________________________________ Date______________
Part Two: This
section of the form must be completed for all overnight trips/activities,
Out-of-State Trips, and Out-of-Country Trips.
All trips of this nature must be submitted for School Committee review
and approval sixty (60) days prior to the scheduled event.
Supervision plan
(attach)
Behavior contract as
necessary – principal’s decision (attach)
Medical release forms
obtained ______yes ______no
Daily Itinerary
(attach)
Health Care
Professional Attending_________________________________________
Administrator
Attending__________________________________________________
The procedures of
this form are in accordance with the Policy of the Gardner Public School
Committee on Field Trips.
[Revised: January 2006]