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Please send at least one week prior to sale Board Agenda Approval for Trip (if needed): ________________________
School: ________________________________ Grade(s) / Group: __________________ Date(s) of Trip: _____________________
Person Requesting C.P. Set Up : _______________________________________________________________________________________
Dept: __________________________________ Phone: _____________________________ Email: ____________________________
First & Last Name of Teacher(s)/Advisor(s): EMAIL@wayneschools.com (If more than 6 use back of form)
Community Pass START Date/Time: _____________________ Community Pass END Date/Time: __________________________
Final Cost Per Student: $ ______________________________ Final Cost Per Chaperone: $ _______________________________
This cost is (check one): Admission Only ____________ Bus Only ____________ Admission & Bus ____________
# A - ADMISSION # of Students _______________________
Student: $ _______________ # of Chaperones ____________________
Chaperone: $ _____________ # of Staff Chaperones ________________
#B - TRANSPORTATION
Trips Only: Transportation Company (select one)
Total Cost: $ ____________ ________ Wayne BOE Transportation
Cost/Student: $ ____________ ________ Other - List Name: _____________________________________________
#C - ADDITIONAL FEES #D - DONATIONS
TOTAL COSTS #A + #B + #C minus #D =
Fees (ie: parking, etc.): $ ____________
Donation Total: $ ___________________ Rounded up Total: $ _______________
Add. Fee Cost per Student: $ ____________ Donation Per Student: $ ______________
Payment DEADLINE: _______________________ (Please refer to the check request schedule)
Deposit (if any) DUE BY: _____________________
Deposit Amount: $ _____________________
Payment/Final DUE BY: ____________________
Payment / Final Amount: $ ______________
Advisor/Principal Approval: _________________________________________________
Date: ___________________________
AFTER THE TRIP/EVENT/SALE
# A - PO# $
# B - PO# $
# C - PO# $
Total paid: $
Attach the approved field trip request with this form to payments@wayneschools.com & keep a copy for your records.
5/30/18 jn
BALANCE: $
Total from Community Pass collected: $
Donation if any: $
Total amount for trip: $
Total collected: $
Minus total paid: $
COMMUNITY PASS SET-UP
FIELD TRIPS / EVENTS / TICKETS
Comments/Additional Instructions:
EVENT/DESTINATION: ________________________________________________________________________________________________
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Completed 10 May 2022

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