Terra Bella Union Elementary School District
9121 Road 240, Terra Bella, CA 93270
www.tbuesd.org
(559) 535-4451
Field Trip Request Form 2022-23
To request a field trip, please fill out the form below.
Name of School?
Please Select
Terra Bella Elemetnary School
Carl Smith Middle School
Name of field trip?
Date of Field Trip
-
Month
-
Day
Year
Date
Name of certificated employee in charge?
Destination
Leaving from school:
Hour Minutes
AM
PM
AM/PM Option
Depart from event:
Hour Minutes
AM
PM
AM/PM Option
Arrival at school:
Hour Minutes
AM
PM
AM/PM Option
Estimated number of miles that you will travel (there and back)?
Have you made contact with the person (destination person) in charge?
Additional Instructions
1. Initiate request at least 2 weeks prior to trip.
2. Fill out field trip request form and turn it into Mr. Flores, Mr. Ruiz for approval.
3. You will need to send permission slips home with your students.
4. Permissions slips must be turned into the office before you leave on your trip.
Meals
Is brunch needed?
Yes
No
Students will walk through at?
Number of students?
Number of adults?
Is lunch needed?
Yes
No
5. Additional Notes
MANAGEMENT USE ONLY
Trip Authorized?
Yes
No
If no, reason for denial?
Funding source for transportation?
Principal signature
Superintendent signature
Submit
Should be Empty: