KAMEHAMEHA SCHOOLS KAPÄLAMA HIGH SCHOOL

FIELD TRIP AND TRAVEL REQUEST FORM

DATE:      
NAME OF       GROUP:      
TEACHER:
TRAVEL DATE(S):       # OF PLACE OF       # OF CHAPERONES:     
STUDENTS:     EVENT:
 
HOW DOES EVENT RELATE SCHOOL PROGRAM/SCHOOL GOALS:
     
IF OTHER THAN EVENING OR WEEKENDS, JUSTIFICATION FOR GOING DURING SCHOOL HOURS:
     

IF EVENT WILL OCCUR DURING NORMAL SCHOOL HOURS AND/OR IS PART OF CLASS
CURRICULUM:
Time students to be       Time to      
excused: return:

Periods students 1 2 3 4 5 6 7 8 9
will be missing HR None
(Check each one)
(Please be sure to check black & white calendar for bell schedule)
Alternate activity      
for non-participating
students:
Periods teacher will 1 2 3 4 5 6 7 8 9
be missing (Check HR None
each one)
How will classes be      
covered:
Event Contact       Event Phone #:      
Person:
PLEASE ATTACH LESSON PLAN AND OBJECTIVES, FOUR (4) COPIES OF YOUR GROUP ROSTER (NAMES AND ID
NUMBERS), TRANSPORTATION & FOOD SERVICE FORMS (IF NECESSARY) TO YOUR DEPARTMENT HEAD.
DISTRIBUTION
1. Copy w/ class list (DH) 2. Copy w/ class list (Unit 11/12) 3. Copy w/ class list (Unit 9/10) 4. Copy (ASC)
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IF EVENT IS TO OCCUR OFF-ISLAND (any off-island travel at ANY time):
PLEASE ATTACH 5 COPIES OF YOUR GROUP ROSTER (NAMES AND ID NUMBERS) TRAVEL ITINERARY,COMPLETED
PERMISSION FORM TEMPLATE AND EMERGENCY CONTACT INFORMATION FOR DISTRIBUTION TO YOUR
DEPARTMENT HEAD, UNIT VPs, BOARDING OFFICE AND PRINCIPAL’S OFFICE.
I certify that the financial obligations for this group are current.
Approve Disapprove Comments:      
Dean of Student Activities Signature Date
I certify that I have attached all required documents and I have cleared any financial obligations
related to my group (if applicable).

Advisor’s Signature Date

I approve the field trip and/or request to travel.
Approve Disapprove Comments:      
Department Head’s Signature
Date
The Field Trip committee approves this group’s request.
Approve Disapprove Comments:      
Field Trip Committee VP’s Signature
Date
APPROVED:
Julian Ako, Principal Date: