FIELDTRIP/BUSREQUESTFORM
(ABOVE AREA FOR CENTRAL OFFICE DATE STAMP) (ABOVE AREA FOR TRANSPORTATION DATE STAMP)
MUST BE RECEIVED IN OFFICE OF ASSISTANT SUPERINTENDENT FOUR (4) WEEKS PRIOR TO FIELD TRIP DATE.
DATE OF APPLICATION ______________________ SCHOOL __________________________ DATE OF TRIP __________________________
DESTINATION _______________________________________________ ADDRESS ________________________________________________
GRADE(S) ________________ # STUDENTS ________________ # TEACHERS/CHAPERONES ________________
TEACHER(S) MAKING REQUEST/IN CHARGE (Full Name) _______________________________________________________________________
PROGRAM: REGULAR CURRICULUM _______________________________, COST PER STUDENT ________________________
WHAT PREPARATION WILL BE DONE IN CLASS FOR THE TRIP? _________________________________________________________________
HOW WILL TRIP BE EVALUATED IN CLASS? __________________________________________________________________________________
BRIEFLY DESCRIBE EDUCATIONAL PURPOSE OF TRIP AND HOW IT ENHANCES CURRICULUM: ______________________________________
_________________________________________________________________________________________________________________________
WHAT ARRANGEMENTS ARE NECESSARY FOR COVERING TEACHER SCHEDULES? ________________________________________________
* WAS NURSE NOTIFIED? Yes No WAS A LIST OF STUDENT'S NAMES GIVEN TO NURSE? Yes No
AFTER TRIP APPROVAL HAS BEEN RECEIVED, TEACHER IN CHARGE WILL SECURE STUDENT PERMISSION SLIPS SIGNED BY THE
PARENT/GUARDIAN PRIOR TO DEPARTURE AND FILE SAME UNTIL TRIP IS COMPLETED.
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TRANSPORTATION REQUEST: (This must be filled out)
WAYNE SCHOOL BUSES CANNOT BE SCHEDULED BEFORE 9:00 A.M. AND MUST BE BACK AT SCHOOL BY 1:30 P.M.
***ALL TRANSPORTATION VEHICLE DECISIONS WILL BE THE PROVINCE OF THE TRANSPORTATION SUPERVISOR.
DESTINATION _________________________________________ ADDRESS ________________________________________________________
TOWN/STATE/ZIP _________________________________________________________________________________________________________
DEPARTURE TIME ___________________ RETURN TIME (AT SCHOOL) ____________________
SPECIAL VEHICLE REQUESTS: _____________________________________________________________________________________________
WHEELCHAIR VEHICLE LUGGAGE COMPARTMENTS NECESSARY OTHER _________________________________
WHO IS RESPONSIBLE FOR COST? BOARD OF EDUCATION _______________________ OTHER ________________________________
FOR TRANSPORTATION DEPT. USE ONLY:
# OF PASSENGERS _______________ # SCHOOL BUSES ________________ # VANS _________________ OTHER _____________________
TYPE OF VEHICLE(S): WAYNE SCHOOL BUSES ______________________ OUTSIDE CONTRACTED ______________________
NAME OF CONTRACTOR ________________________________________________________ APPROX. COST __________________________
A/C CHARGE: Elementary _____ Secondary _____ Special Ed _____ EOP/ENVIRON. ED _____ OTHER A/C # ___________________
CHARGE TO: ACCOUNT # ___________________________________________ OTHER: ___________________________________________
APPROVED BY: * SCHOOL NURSE _________________________________________________ DATE ___________________________
PRINCIPAL ______________________________________________________ DATE ___________________________
DIRECTOR ______________________________________________________ DATE ___________________________
SUPERINTENDENT / ASSIST. SUPT. _________________________________ DATE ___________________________
** TRANSPORTATION SUPERVISOR ___________________________________ DATE ___________________________
* NOTE: MAKE A COPY BEFORE SUBMITTING FOR APPROPRIATE SIGNATURES…..(central office sends trans 2 cc)
