Petaluma City Schools | E 6153 Instruction
OVERNIGHT OR EXTENDED FIELD TRIP/OUTDOOR EDUCATION REQUEST
DIRECTIONS: This form must be completed and submitted to the ASSISTANT SUPERINTENDENT, CURRICULUM & INSTRUCTION one month prior to the proposed trip, but not less than 15 days before the board of Education meeting when it is to be considered. Exceptions may be made to this timeline for events such as playoff competition. Request that do not meet the above timelines may require teacher or principal presentation to the Board of Education requesting emergency Board action.
The Principal of the site is responsible for having all district policies and regulations followed for Board Policy and Administrative Regulation # 6153, School-Sponsored Trips.
All trips involving out-of-state or overnight travel shall require the prior approval of the Petaluma City School Districts Board of Education. Other trips may be approved by the Superintendent or designee (site administrator).
TEACHER NAME: SCHOOL SITE:
DATE OF REQUEST:
2. Purpose of trip:
3. Date(s) of trip:
4. Name of student group:
5. Number of students: Total Boys Girls
6. Describe the housing arrangements:
7. Will there be any form of water activities? No___ Yes___
If yes, Board Policy and Administrative Regulation # 6153 must be adhered to. The Principal must submit a summary of how this was accomplished by the site to the Assistant Supt. Of Curriculum & Instruction.
8. Names of the Certificated Faculty Supervisor(s)
Names of other Adult Chaperone(s):
Total number of chaperones including faculty supervisors: Male___ Female___
9. Chaperone fingerprints cleared through Human Resources? Yes?_____ No?_____
10. Cost for each student to attend this field trip: $_______ How is the field trip being funded?_______________________. Parent's funding for a field trip is to be considered a donation. Arrangements for inclusion of all students of the class or group must be made, regardless of their ability to pay.
11. Mode of transportation:_____________________________. If school or commercial bus is used it must be approved by the Director of Transportation. If private vehicles are used form PB 276 must be completed for each vehicle and approved by the principal in advance of the trip. Has the Director of Transportation been notified?
Yes? _________ Date_________ No?_________ Comments:
12. In considering the approval or disapproval of a field trip the school principal shall take into consideration at least the following: safety of the location to visited, financial impact of possible cancellation, parental attitude, the appropriateness of the mode of travel, and the equality of opportunity for student participation.
13. Approval Signature of Site Administrator: Date:
Approval Signature of Assist. Supt. C/I Date of Board Approval:
Exhibit PETALUMA CITY SCHOOLS
version: September 25, 2007 Petaluma, California