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PASO ROBLES JOINT UNIFIED SCHOOL DISTRICT
REQUEST FOR OVERNIGHT FIELD TRIP AND
DAY TRIPS OVER 150 MILES ONE WAY
(To allow for proper processing overnight field trip requests must be submitted 15 days prior to a scheduled Board meeting, on CAO’s
desk. Any trip taken without prior Board approval may result in consequences such as paying your own trip out of pocket and/or possible
disciplinary action.)
PLEASE TYPE IN INFORMATION
Form completed by:
Site:
Destination:
School/Organization:
Dates/Times:
Student Grade(s) attending:
Leave Day: SELECT
SELECT
Date:
Time:
PM
Return: SELECT
SELECT Date:
Time:
PM
School Day: YES
Purpose of trip:
Brief Itinerary:
Name of Requestor(s)/Teacher(s):
Date:
If male and female students are attending, male and female chaperones must also comply with Board Policy (BP/AR 6153 School Sponsored Trips)
Chaperones must be age 21 or older (AR 6153 School Sponsored Trips).
Chaperone Ratios: Day & Overnight Field Trips 1:20, Water Activities 1:10, Backpacking Trips 1:7
Number of female students attending:
Number of male students attending:
Number of female chaperones attending:
Number of male chaperones attending:
Type of transportation SELECT
If other explain
SELECT
**if private auto, proof of insurance must be filed with District Business Office
A request for transportation MUST be sent to the Transportation Department including the use of charter transportation.
If sack lunches are to be prepared, a request for food services should be sent to the Food Services Department
Name of funding source:
Cost to District: $
Cost per Student: $
All overnight and day trips must be approved by the site Principal prior to submission to CAO’s office.
Emailing this form to the CAO’s Assistant by the site Principal will be considered a signed copy of the site Principal’s approval.
Note: Adobe Read/Write is required to use this form; if you do not have access to Adobe, please contact your site secretary.
FOR DISTRICT OFFICE USE ONLY
 Fingerprint clearance for chaperones confirmed (full screening required for overnight trips)
 Megan’s Law clearance chaperones confirmed ( required for day trips)
 Not Applicable – Chaperones are Paso Robles Joint Unified School District Staff
Director (Print Name)
Signature
Date
Signature
Date
Babette DeCou
Chief Academic Officer (Print Name)
PRJUSD BOARD ACTION
YOUR FIELD TRP HAS BEEN:

APPROVED

DENIED
Duane Wolgamott
Chief Business Officer (Print Name)
Ravery10.26.15
Signature
Date
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PASO ROBLES JOINT UNIFIED SCHOOL DISTRICT
REQUEST FOR OVERNIGHT FIELD TRIP AND DAY TRIPS OVER 150 MILES ONE WAY
ADDITIONAL CHAPERONES
If male and female students are attending, male and female chaperones must comply with Board Policy for overnight and day trips (BP 6153
School Sponsored Trips). Chaperones must be age 21 or older (AR 6153 School Sponsored Trips).
Names of Female Chaperones
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Teacher/Parent/Other*
*If “other”, please specify.
Names of Male Chaperones
Teacher/Parent/Other*
*If “other”, please specify.
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PASO ROBLES JOINT UNIFIED SCHOOL DISTRICT
REQUEST FOR OVERNIGHT FIELD TRIP AND DAY TRIPS OVER 150 MILES ONE WAY
STUDENTS ATTENDING
FEMALE STUDENTS
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Grade
MALE STUDENT
Grade
3 of 4
PASO ROBLES JOINT UNIFIED
SCHOOL DISTRICT
P.O. Box 7010
Paso Robles, CA 93447
(805) 769-1160
No.___________________
TRIP / TRANSPORTATION REQUEST
(Must be submitted two weeks prior to trip)
Section 1
DATE OF REQUEST:
DATE OF TRIP:
SCHOOL:
TEACHER:
DESTINATION:
OTHER CHAPERONES:
AM
PM
DEPARTURE TIME
PURPOSE (Select one):
FIELD TRIP
TRANSPORTATION REQUESTED:
AM
PM
RETURN TIME:
EXTRA-CURRICULAR
BUS
VAN(S)
WALK
(Explain other):
CONF/MEETING
# of Passengers
OTHER:
OTHER:
IF VAN(S), LIST DRIVER(S):
OTHER STOPS REQUIRED (Eating, Resting, etc.):
PURPOSE (Tell how this trip relates to goals and objectives of course).
REQUESTOR’S NAME:
*If bus requested, bus driver must have a copy of passenger list. Listing all persons on board.
*All persons picking up district vehicles, must have a current District Driver Class Certification
Section 2
PROGRAM CODE:
.
. .
.
.
.
.
.
DATE:
SPECIAL BILLING (Explain)
APPROVAL: PRINCIPAL/DESIGNEE (Signature):
Section 3
DATE:
APPROVAL: CHIEF ACADEMIC OFFICER (Signature)
Section 4
DATE:
APPROVAL: ACCOUNTING/BUDGET (Signature)
Section 5
DATE:
APPROVAL: TRANSPORTATION (Signature)
DATE:
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