File: IJOAA-E
REQUEST TO THE SCHOOL COMMITTEE FOR OVERNIGHT
AND OUT OF STATE TRIP AUTHORIZATION
THIS REQUEST MUST BE APPROVED BY THE SCHOOL COMMITTEE PRIOR TO PUBLICATION OF THE TRIP AND COLLECTION OF MONEY
School ___________________________________ Trip Location
1. Today's date Event Coordinator/s _________________________
2. Name, location and description of trip/event (Include name of sponsoring organization if other
than a school-sponsored student group)
3. Date(s) of the Trip/Event for which School Committee authorization is being sought _________
4. Explain how this activity supports the mission of the school, the curriculum and/or the goals
of the student organization
________________________________________________________________________________________________
________________________________________________________________________________________________
5. Estimated number of students who will participate in the trip
6. List the names and roles of the chaperones (10 to 1 staff/student ratio is recommended. If not meeting this ratio,
please explain:_______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. What safety procedures are in place for supervisions and medical emergencies? ____________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
File: IJOAA-E
Financial Information
8a. Cost per student $ X # of students = $
8b. Cost of Program $ Cost of Transportation $
8c. Cost per Chaperone $ Cost paid by Chaperone $
8d. Chaperone cost included in student fee? Yes No
8e. Identify fund raising used to lower cost per student or subsidize student fees
8f. How much money do you anticipate raising to offset the cost to students?
8g. Identify any other costs of participating in this trip/program, e.g., extras,
optional activities, etc.
8h. Are all meals, including those while in transit, included in the per student
fee? (If no, identify) Yes No
Explain the cancellation and refund policy
_________________________________________________________________________________________
Additional Information _____________________________________________________________________________
Staff Members Signature _______________________________________ Date ______________________
Principal's Approval Signature Date
Superintendent's Approval Signature ______________________________ Date
Attach ten (10) copies of all the literature (letters, flyers, brochures, etc.) that will be sent to
parents and/or distributed to students regarding the trip/event
Any staff member who is getting the trip for free must complete a disclosure form if the value is more than $50.00 and send in to the Superintendent’s office before attending the trip.
File: IJOAA-E
Out of State and Overnight Field Trip Checklist
In order to be approved, all conditions must be met
_____ The trip is appropriate for the age group involved.
_____ The trip is reasonable in terms of time, distance and cost.
_____ The trip is not scheduled during the last week of the school year.
_____ Extra-curricular international and domestic field trips occurs mostly during
non-school times _____ school days are approved.
_____ The trip is not scheduled during MCAS testing.
_____ Chaperones are sufficient and cleared to supervise students.
_____ There are sufficient provisions for medical emergencies.
_____ The transportation provider is licensed for passenger transportation by Federal
Motor Carrier Administration. No subcontractor is being used.
_____ Cost associated with optional & voluntary extra-curricular field trips is the
responsibility of the individual students & family.
_____ Parents must be informed they should be able to but not required to purchase trip
insurances. Parents are aware of the different levels of insurances available
and liability should the cancellation of the field trip be needed.
_____ The trip is approved
_____ The trip is approved with the following conditions:_______________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
_____ The trip is not approved for the following reasons: _______________________________________________
__________________________________________________________________________________________
_____________________________________________________________________________________________
School Committee Chair: __________________________________________ Date: ____________________
Source: Georgetown
Adopted on: April 24, 2008
Revised on: December 14, 2017