<p> BARREN COUNTY SCHOOLS FIELD TRIP REQUEST FORM 2016-2017</p><p>DATE OF TRIP:______SCHOOL: ______</p><p>GROUP/TEACHER: ______</p><p>DESTINATION: ______</p><p>TIME OF DEPARTURE:______TIME OF RETURN ______</p><p>Total # of Male Students: ______Total # of Female Students: ______Total # of Male Chaperones: _____ Total # of Female Chaperones: ______Grade Level of Students Making Trip:______</p><p>Total Number of Buses Needed:______Drop Off/Pick up Only: ______Out of County: ______Overnight of Out of State:______</p><p>Lunches required from Nutrition Services: Yes______No _____</p><p>Special Needs Bus: ______Lift:______Harness: ______</p><p>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.)</p><p>Educational Objective of the Trip: ______</p><p>______TEACHER NAME TEACHER PHONE DATE </p><p>ADMINISTRATOR APPROVAL: ______</p><p>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.</p>