Fillable Field Trip Request Form Minor (Mt. San Jacinto Community College District)

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Field Trip Request Form Minor (Mt. San Jacinto Community College District)

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Revised Form 07/10/2012
Field Trip Request Form (Minor)
MUST BE SUBMITTED 10 BUSINESS DAYS PRIOR TO FIELD TRIP
Check One:
_____One Day, School Day
______One Day, Non-School Day
______Overnight Trip, # of Nights
______Out of State Trip
Destination:_______________________________________________________________________________________
Educational Benefit/Purpose of Trip:___________________________________________________________________
_________________________________________________________________________________________________
Program associated with Field Trip:___________________________________________________________________
Departure Date & Time:_______________________________Return Date & Time______________________________
City _______________________________________________________State__________________________________
Closest Hospital/Emergency Room:____________________________________________________________________
Adult In Charge:______________________________________________Cell Number__________________________
Additional Adult In Charge:_____________________________________Cell Number__________________________
List all Chaperones:_________________________________________________________________________________
_________________________________________________________________________________________________
Only District Vehicles will be allowed to transport Minors on Field Trips, please call Facilities in advance for booking
REQUIRED
_________Check here for attached list of participants and class handouts for Field Trip.
_________ Check here indicates all medical authorization forms and permission slips have been received. These forms must be
kept in associated department for one year after the date of the field trip.
Faculty Member____________________________________________________________________Date__________
Instructional Dean__________________________________________________________________Date___________
Appropriate Area Dean______________________________________________________________Date___________
Risk Management, Business Services___________________________________________________Date___________
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Field Trip Request Form Minor (Mt. San Jacinto Community College District)

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Completed 23 July 2020

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