Student's Name:       

Grade: 

Date(s) of proposed absence:

Start Date:   

End Date: 

Person(s) directing and/or supervising during above absence: 

Name(s): 

Phone 1:  

Phone 2:   (Optional) 

Address: 

 

• Itinerary of trip - Include experiences which could be educational in nature and will therefore, provide the child with some valuable experience outside of the classroom. 

 

• We have read the tour or trip guidelines in the student handbook and are aware of the responsibilities, which we have assumed or assigned to someone else. We further agree to abide to the stipulations as set forth in the guidelines. We also acknowledge that it is the student's responsibility to request assignments from their teachers.

Parent/Guardian Name:     

Date: 

Phone 1:   

Phone 2:   (Optional) 

Email address: 

 

Failure to submit this form 5 school days prior to the trip may result in days missed being marked as unexcused. A limit of 10 days per school year may be approved for educational trips. Days beyond 10 will be considered unexcused.

 

*****************************************************************************************************************************************

Internal Use Only

 

Approved: 

Not Approved: 

Conditional Approval: 

School Official Name:    

Date of approval: 

Notes from school official: 

Security Measure

google recaptcha