Barren County Schools s1
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BARREN COUNTY SCHOOLS FIELD TRIP REQUEST FORM 2016-2017
DATE OF TRIP:______SCHOOL: ______
GROUP/TEACHER: ______
DESTINATION: ______
TIME OF DEPARTURE:______TIME OF RETURN ______
Total # of Male Students: ______Total # of Female Students: ______Total # of Male Chaperones: _____ Total # of Female Chaperones: ______Grade Level of Students Making Trip:______
Total Number of Buses Needed:______Drop Off/Pick up Only: ______Out of County: ______Overnight of Out of State:______
Lunches required from Nutrition Services: Yes______No _____
Special Needs Bus: ______Lift:______Harness: ______
Cargo Boxes Requested: Yes_____ No_____ (Note: Buses with cargo boxes are very limited, but we will try to fill your request if at all possible.)
Educational Objective of the Trip: ______
______TEACHER NAME TEACHER PHONE DATE
ADMINISTRATOR APPROVAL: ______
INFO: DRIVER RATE - $14.00 PER HOUR MILEAGE RATE - $1.75 PER MILE OUT OF COUNTY – 44 TOTAL PASSENGERS THIS FORM MUST BE SUBMITTED 3 WEEKS IN ADVANCE OF THE TRIP TO THE FIELD TRIP COORDINATOR AT YOUR SCHOOL. PLEASE DO NOT FAX REQUESTS TO THE BUS GARAGE.