Field Trip Request Form

Email(Required)

Requested Field Trip(Required)

Location(Required)

Include name of destination and address

Round Trip Mileage(Required)

must be less than 50 miles one way

Date(s) Requested(Required)

include several proposed dates if possible

Location Contact Information(Required)

Include name of contact at location, phone number and email

Will packed lunches be required?(Required)

Will you be inviting parents to attend?(Required)

Proposed Number Traveling(Required)

Include, Teachers, Students, TAs and parents

Cost Per Person (Students and Adults)(Required)

Must be under $15 per attendee

What are the payment arrangements and options?(Required)

pre-paid via credit card is preferred, if check, must be finalized Friday prior to trip

Proposed Time to Depart from Headwaters(Required)

do not plan to leave before 8am

Proposed Time to Return to Headwaters(Required)

must be back at Headwaters no later than 2pm

How does this trip align with curriculum?(Required)

How will students be prepared for this trip?(Required)

How will you determine that the trip was successful?(Required)

Date(Required)