FIELD TRIP REQUEST (Date of Request: _________________)

Class or Activity: ___________ Date of Trip: _________

Purpose of Trip: _____________________________________

Estimated number of students involved: ______________ Permission Slips: _____

Destination: __________________________ (include physical address)

Approximate Distance: __________________________

Departure Time __________ Estimated Time of Return _________

Departure Location ___Trinity Lutheran School 8701 Huey Rd Hoffman, IL 62263

Special Requests:

_____________________________________________________________________________

Trip Funded by: _______school__________

Permission Granted ___ Denied ____

Approved by: __________________________

_____________________________________________________________________________

Transportation Department

Trip # _______ Equipment: Bus ____ suburban ______ Traverse ______

Date Received ___________________

Driver Assignment ___________________________ Accept ______ Reject ______

Date Assigned _____________________ Transportation __________________________