NEW BEDFORD PUBLIC SCHOOLS
SCHOOL SPONSORED FIELD TRIP/FIELD DAY REQUEST

Regardless of funding or transportation needs, all requests must be sent to the Chief Academic Office for approval.

Name of Staff Member Requesting Permission:		Date:		

School:		Grade:		Subject:		

1.	TYPE OF REQUEST: Check appropriate area(s)	

	Field Trip: In-state		Trips/Exchanges		International	

	Field Trip: Out-of-state	 	Overnight		Field Day	

	Extracurricular	

PLEASE NOTE:  School Committee approval required beforehand on ALL
Out-of-state and Overnight trips.

2.	TRIP INFORMATION:	

a.	Date(s) of Trip/Field Day:		

b.	Location:		

Address:		City:		State:		

c.	Transportation:  Walking Tour		    Bus		    Train		    Airplane		

	Please arrange transportation for my group.	
Source of funds:	
	Local School Budget		Grant:		
	School Activities Fund		PTO:		
			Other:		

	I will coordinate my own transportation.	

SPECIAL BUSSING (ex: wheel chair van, car seats,):		

d.	Departure/arrival information:  Location of Pickup		
(Street)	

Time of departure from school:	             	Time of arrival at destination:	             	

Time of departure from destination:	             	Time of return to school:	             	
	
e.	Number of students:		Number of chaperones:		

f.	Names of teachers and chaperones:		

3.	Fill in all that apply: 	

a.	Total cost per student:		

b.	Source of funds:		

c.	Provision for meals:		Where will you eat lunch?		

d.	Emergency telephone contact at destination:		

4.	Purposed of Trip/Connection to curriculum:		

	

	

5.	Nursing:	

Special medical requirements:		

	A nurse needs to attend		A nurse does NOT need to attend	

Nurse:		Date:		Approved:		Denied:		
(School nurses are not able to grant approval for field trips that take place after school hours and/or weekends).

By signing below, I certify that the appropriate medical emergency forms have been collected from all students.  

Principal:		Date:		Approved:	       	Denied:	       	

Superintendent’s/Asst. Supt. Office Use only:	
	
	Nursing Supervisor:		
Date:		
Approved:	
       	
Denied:	

	Superintendent or Designee:		
Date:		
Approved:		
Denied:			

Submitted to Transportation on:		

Submitted to Special Ed on:		

Rev. 9/2015