Fillable Field Trip Request FormADULT Student (Mt. San Jacinto Community College District)

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Field Trip Request FormADULT Student (Mt. San Jacinto Community College District)

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Revised Form 07/10/2012
Field Trip Request Form
(Student/Adult)
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
______Trip to Foreign Country
Destination:_______________________________________________________________________________________
Educational Benefit/Purpose of Trip:___________________________________________________________________
_________________________________________________________________________________________________
Class 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__________________________
Other Adults on Trip:_______________________________________________________________________________
Transportation (check one, please):
District Vehicle_______
Student Vehicle_______
REQUIRED
_________Check here for attached list of participants and class handouts for Field Trip.
_________ Check here indicates all participants have completed the required/applicable field trip forms (MSJC Excursion notice,
Activity Waiver and personal Vehicle Use). These forms must be kept in associated department for one year after the date of the
field trip.
Faculty Member____________________________________________________________________Date__________
Appropriate Area Dean______________________________________________________________Date___________
Risk Management, Business Services___________________________________________________Date___________
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Field Trip Request FormADULT Student (Mt. San Jacinto Community College District)

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Completed 23 July 2020

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