FIELD TRIP REQUEST: PERMISSION TO LEAVE SCHOOL CAMPUS
School: ______________________________ Date of Departure: __________ Time: ________
Teachers: ____________________________ Date of Return: _____________ Time: ________
Destination: ______________________________________ Event: _______________________
Method of Financing Trip: ________________________________________________________
Number in Group: _____ Funding Cut-Off Date: ___________ Cost Per Student: ___________
** Mode of Transportation (check one):
______ City School Bus (see back)
______ City Special Ed Van (see back)
______ School Van
______ Other - Specify ___________________
Arrangements for Assisting Students Who Need Financial Help: _________________________
_____________________________________________________________________________
Chaperones: __________________________________________________________________
Arrangements for Making Up Classwork Missed: _____________________________________
_____________________________________________________________________________
Educational Goals of Trip: _______________________________________________________
Will students be away from school during lunch? _____ Yes _____ No If yes, date cafeteria was
notified __________________ (Note: It is the responsibility of the teacher to notify the cafeteria.)
CERTIFICATION OF PARENTAL PERMISSION:
I certify that I will obtain written parental permission for each student who will take part in this
off-campus trip. I will inform parents in writing that the Student Code of Conduct, including the
mandatory penalties section, is enforced during all off-campus school activities.
Signature of Staff Member: ______________________________________ Date: __________
School Nurse has reviewed list of students:__________________________ Date:___________
PRINCIPAL’S ACTION:
________ Approved ________ Disapproved Comments: ____________________________
Principal’s Signature: ___________________________________________ Date: ___________
BOARD’S ACTION (Overnight trips only):
________ Approved ________ Disapproved Comments: _____________________________
Signature of Supt./Designee: ______________________________________ Date: __________
**Drivers of private vehicles are required to state proof of insurance prior to the trip.
Form Updated February 2012
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DATE SUBMITTED: ________
TRANSPORTATION REQUEST
JOHNSON CITY TRANSIT
(Complete only if school buses are requested)
School: ______________ Teacher in Charge: _______________________ Number in Group: ______
Date of Trip: __________ Return Date: __________ Destination: ____________________________
Depart Time From School: _______________ Return Time To School: _______________
Please list separately all accompanying staff members: _____________________________________
SEND BILL TO: _______________________________________________________________________
Comments: (Include special instructions) _________________________________________________
TRANSIT USE ONLY
Principal’s Signature:
Date:
JCT’s Signature:
Date:
Est. Round Trip Miles
per/bus
Size of Bus ______ 28 passenger
Size of Bus ______ 60/78 passenger
Size of Bus ______ 56/72 passenger
IT IS THE TEACHER’S RESPONSIBILITY TO ACCOUNT FOR ALL PASSENGERS
1. FAX FORM TO 434-6280 A MINIMUM OF FIFTEEN (15) WORK DAYS BEFORE THE TRIP.
2. Bus must return by 2 p.m. A $50 late return penalty will be assessed due to teacher neglect.
3. Vehicle capacity:
60 high school & middle school / 78 elementary
56 high school * middle school / 72 elementary
28 passengers
4. On board luggage, instruments, bag lunches, coolers, or other articles must be securely fastened. Aisles
will remain clear at all times. Excess luggage may be carried in a separate vehicle. Each school should
have their own bungee cords to tie down lunch coolers.
5. Field trips can be taken between the hours of 8:15 a.m. – 2 p.m.
6. Field trips are limited to a 60-mile radius (one way)>
7. Transportation request form must be completed in roller ball or INK. Please do not use pencil or neon
colors.
8. To cancel a trip
- If you cancel on the date of the trip call 929-7119.
- If you cancel prior to date of the trip, write cancel on the request form and fax.
9. No field trips on school ½ days.
FLAT RATE $__________ per Bus
JCT RESERVES THE RIGHT TO CANCEL ANY TRIP AS NECESSARY DUE TO UNFORESEEN
CIRCUMSTANCES, FUEL SHORTAGE, OR WEATHER CONDITIONS. QUOTED COST MAY
CHANGE IF FUEL PRICES DRAMATICALLY INCREASE OR DECREASE.
Form Updated February 2012
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