Berlin Central School District

Middle School/High School

Field Trip Application

to be filled out in triplicate-  submit to building principal

Submit 90 days prior for overnight~ ~30 days for day field trip

 

Destination________________________________ Class/group__________________________

 

Itinerary (attach separate sheet if detailed) ___________________________________________

 

Departure date _____________Departure time_____________ Trip less than 100 miles     yes    no

 

Return date________________ Return time ______________  Trip is overnight      yes  no

 

Number of students ______________    Number of chaperons _________________

 

List of chaperones ________________________; _____________________; __________________;

 

___________________________;   ________________________; __________________________;

 

___________________________;  ________________________; ___________________________;

 

Per student cost of trip $ __________ (part paid by each student) Remainder paid by ________________

 

Teacher sponsor (s) ________________________________ Today’s Date _________________

 

Transportation:

 

_______ privately owned vehicle (administrative approval needed) ___________________

 

_______ school bus(s)                # busses requested _____________

 

_______ public transportation (plane, train, bus) _____________ Company (if known) _____________

 

_______ charter bus ( attach forms)  company_______________________

 

_______ other: specify __________

 

In addition to Principal/Assistant Principal-

In town contact person (for after school hours)  ________________________  phone _______________

 

Approval:

 

Building Principal _____________________________________________  Date _______________

 

Superintendent _______________________________________________ Date _______________

 

Board of Education ____________________________________________ Date _______________

 

Transportation Supervisor _______________________________________ Date _______________

 

TS returned signed approved copy to requesting teacher.

 

_____ Building Nurse

_____ Quality Food Management

_____ Head Teacher/Secretary

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