Dallas Form F4 B – Fill Out and Use This PDF

DALLAS INDEPENDENT SCHOOL DISTICT

OFFICE USE ONLY

Complete FTP Received Date:

CAMPUS FIELD TRIP PROPOSAL (FTP)

Incomplete FTP Returned Date

Pre-Approved Destination

IN-COUNTY OR OUT-

OUT-OF-

OUT-OF-

OUT-OF-

NON-DIS-

IN-COUNTY

OF-COUNTY OVER-

UIL

COUNTY

STATE

COUNTRY

TRICT EVENT

(15 Day Notice)

NIGHT

(15 Day Notice)

(30 Day Notice)

(45 Day Notice)

(15 Day Notice)

CAMPUS:

DIVISION:

(Please follow Policy FMG (Local) & FMG (Regulation) that pertains to school-sponsored trips, excursions, tours, and District’s field trip guidelines.)

DESTINATION INFORMATION

Destination:

Has the campus participated in a previous field trip to

Departure:

this destination within the past school year?

(Date/Time)

Yes

No

Physical Address:

ZIP:

Return:

(Date/Time)

GROUP TRAVELING

Student Group (i.e. Student Council, Choir, etc.):

Number of Students:

Grade(s):

Number of Faculty:

Number of Non-Staff:

(Count must Coincide Student List)

LEARNING EXPECTATION

Instructional Purpose:

TRIP SPONSOR

First & Last Name:

Cell Phone:

OVERNIGHT ACCOMODATIONS

Hotel Name:

Physical Address:

ZIP:

Phone Number:

FUNDING SOURCE

Activity Fund

Arts Partners

Grant

General Operating

Other:

Campus Action Plan #:

TRIP TOTAL

FUNDRAISERS

SCHOOL PAYMENT PLAN

STUDENT PAYMENT PLAN

$

Type & Dates:

Amounts & Dates:

Amounts & Dates:

TRANSPORTATION

Charter Bus

Dallas County Schools Trip#:

Airplane

Walking

Other:

UNIQUE POTENTIAL HAZARDS EMERGENCY PLAN

1. Plan with school nurse.

2. Call 911.

3.

Contact school.

4. Render first aid for minor emergencies.

5. Notify parent/guardian.

6. Provide written notice upon return.

Name of Nearest

Physical

Phone#:

Medical Facility:

Address:

REQUIRED SIGNATURES

Confirmed accuracy and completion of trip information & documents in

Trip Sponsor:

Date:

adherence to Policy FMG (LOCAL) and FMG (REGULATION)

Reviewed FTP Packet

Trip Coordinator:

Date:

Approved

Principal:

Date:

Approved

Executive Director:

Date:

SIGNATURES FOR IN-COUNTY OVERNIGHT, OUT-OF-COUNTY, OUT-OF-STATE AND OUT-OF COUNTRY FIELD TRIP PROPOSALS

Approved

Assistant Superintendent:

Date:

(For In-County Overnight & Out–of-County)

Approved

Chief of School Leadership:

Date:

(For Out-of-State and Out-of-Country Only)

September 2013

FORM F4-B