NDCL Field Trip Planning Form

Please complete the following form as fully as possible. After she reviews your request, Mrs. Ricci will notify you by email if your proposed field trip is approved.

Requests must be submitted at least two weeks before the proposed trip.

Today's date: * +

Name of person submitting this form: *

Email address of person submitting this form: *

Name of class or group participating: *

Number of students participating: *

Activities in which students will be engaged: *

Date of trip: * +

Destination of trip: *

Actual address of destination: *

Total number of passengers, including chaperones: *

What time will you load/van/bus? *

Time students need to arrive at destination: *

Departure time from destination: *

Name(s) of chaperones who will ride with students:

Special instructions, if any, for Mr. LeMay as he arranges transportation:

Regarding lunch, participants will: *

eat lunch at school.

eat lunch at this location: eat lunch at this location:

Regarding attire, participants will: *

wear the regular uniform.

wear the dress uniform.

wear dress-down clothing.

Rationale for this decision: *

Please list the name and substitution needs of each chaperone separately.

LEAD faculty chaperone: *

LEAD faculty cell phone number: *

	Block 1	Block 2	Activity/Study Hall	Block 3	Block 4	Block 5	Block 6	Activity/Study Hall	Block 7	Block 8
Substitution needed for:	Block 1	Block 2	Activity/Study Hall	Block 3	Block 4	Block 5	Block 6	Activity/Study Hall	Block 7	Block 8

Faculty chaperone #2:

	Block 1	Block 2	Activity/Study Hall	Block 3	Block 4	Block 5	Block 6	Activity/Study Hall	Block 7	Block 8
Substitution needed for:	Block 1	Block 2	Activity/Study Hall	Block 3	Block 4	Block 5	Block 6	Activity/Study Hall	Block 7	Block 8

Faculty chaperone #3:

	Block 1	Block 2	Activity/Study Hall	Block 3	Block 4	Block 5	Block 6	Activity/Study Hall	Block 7	Block 8
Substitution needed for:	Block 1	Block 2	Activity/Study Hall	Block 3	Block 4	Block 5	Block 6	Activity/Study Hall	Block 7	Block 8

Special instructions, if any, for Mr. Poulos as he arranges substitutions:

If available, please attach invoice.

Cost per student (admission fees, ticket costs, etc.):

If applicable, check should be written for this TOTAL amount:

If applicable, the Finance Office should make check payable to:

If applicable, the Finance Office should:

give the check to the person organizing the trip.

mail the check. (Give complete address in special instructions below.)

Special instructions, if any, for the Finance Office: