Field Trip & Activity Request Form
Instructions: Use this form to request permission for all field trips/activities not listed in the Calendar of Events. Submit the completed form to the Office of Student Services at least TWO weeks in advance of the trip. If the trip involves any time period between 7:45 am, Monday, and noon, Friday, while classes are in session, submit the form at least THREE weeks in advance.
Instructor/Supervisor Name
*
First Name
Last Name
Instructor/Supervisor Email
*
Academic Term of Event
*
Ex. Fall 2023/24
Is this request for a Academic Field Trip?
*
YES
NO
Club/Organization (if non-academic trip)
*
Does this trip take place during an Academic Day?
*
YES
NO
Will this trip require overnight stays?
*
YES
NO
What accommodations and meals will be provided for this overnight trip?
*
Will you require multiple trips throughout the semester?
*
YES
NO
How many trips will you require approval for this semester?
*
2
3
4
5
6
How many courses will attend this trip?
*
1
2
3
Course 1 Prefix & Number
*
Ex. BIOL110
Course 1 Name
*
Course 2 Prefix & Number
*
Ex. BIOL110
Course 2 Name
*
Course 3 Prefix & Number
*
Ex. BIOL110
Course 3 Name
*
Sponsors/Volunteers
*
Departure Date
*
-
Month
-
Day
Year
Date
Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Return Date
*
-
Month
-
Day
Year
Date
Return Time
*
Hour Minutes
AM
PM
AM/PM Option
Transportation
*
Destination
*
Purpose of Trip/Activity
*
List student(s) involved (alphabetized: Last name, First name)
*
Possible Risks - Potential hazards may include but are not limited to the following:
*
Cabin use/cooking – burns from woodstove, camp stoves, or cooked food; falling off ladder or bunk; cuts from hatchets,knives, or camping implements, insect bites or stings.
City – traffic hazards; separation from group; unwanted approaches from strangers
Driving – motor vehicle accidents or injuries
Hiking – injuries sustained hiking on uneven and/or unstable ground; falling from heights, footbridges, or tripping; fallingrocks or trees; hostile wildlife, cuts or abrasions from sharp sticks and rocks; hypothermia, dehydration, exhaustion
Lakes and Rivers – drowning, falling into creeks, injuries from being swept downstream, hypothermia or illness fromcontaminated water, possibly small bruises or blisters
Weather – lightning, hail, debris from wind, water, or flooding, warm and cold temperatures, remote chance of mudslidesor avalanches
Athletic Event – broken limbs, concussion, soft tissue injuries, dental injuries, bruises
Other - Note below
Please note other possible risks not mentioned above.
Trip #2 Sponsors/Volunteers
*
Departure Date
*
-
Month
-
Day
Year
Date
Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Return Date
*
-
Month
-
Day
Year
Date
Return Time
*
Hour Minutes
AM
PM
AM/PM Option
Transportation
*
Destination
*
Purpose of Trip/Activity
*
List student(s) involved (alphabetized: Last name, First name)
*
Possible Risks - Potential hazards may include but are not limited to the following:
*
Cabin use/cooking – burns from woodstove, camp stoves, or cooked food; falling off ladder or bunk; cuts from hatchets,knives, or camping implements, insect bites or stings.
City – traffic hazards; separation from group; unwanted approaches from strangers
Driving – motor vehicle accidents or injuries
Hiking – injuries sustained hiking on uneven and/or unstable ground; falling from heights, footbridges, or tripping; fallingrocks or trees; hostile wildlife, cuts or abrasions from sharp sticks and rocks; hypothermia, dehydration, exhaustion
Lakes and Rivers – drowning, falling into creeks, injuries from being swept downstream, hypothermia or illness fromcontaminated water, possibly small bruises or blisters
Weather – lightning, hail, debris from wind, water, or flooding, warm and cold temperatures, remote chance of mudslidesor avalanches
Athletic Event – broken limbs, concussion, soft tissue injuries, dental injuries, bruises
Other - Note below
Please note other possible risks not mentioned above.
Trip #3 Sponsors/Volunteers
*
Departure Date
*
-
Month
-
Day
Year
Date
Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Return Date
*
-
Month
-
Day
Year
Date
Return Time
*
Hour Minutes
AM
PM
AM/PM Option
Transportation
*
Destination
*
Purpose of Trip/Activity
*
List student(s) involved (alphabetized: Last name, First name)
*
Possible Risks - Potential hazards may include but are not limited to the following:
*
Cabin use/cooking – burns from woodstove, camp stoves, or cooked food; falling off ladder or bunk; cuts from hatchets,knives, or camping implements, insect bites or stings.
City – traffic hazards; separation from group; unwanted approaches from strangers
Driving – motor vehicle accidents or injuries
Hiking – injuries sustained hiking on uneven and/or unstable ground; falling from heights, footbridges, or tripping; fallingrocks or trees; hostile wildlife, cuts or abrasions from sharp sticks and rocks; hypothermia, dehydration, exhaustion
Lakes and Rivers – drowning, falling into creeks, injuries from being swept downstream, hypothermia or illness fromcontaminated water, possibly small bruises or blisters
Weather – lightning, hail, debris from wind, water, or flooding, warm and cold temperatures, remote chance of mudslidesor avalanches
Athletic Event – broken limbs, concussion, soft tissue injuries, dental injuries, bruises
Other - Note below
Please note other possible risks not mentioned above.
Trip #4 Sponsors/Volunteers
*
Departure Date
*
-
Month
-
Day
Year
Date
Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Return Date
*
-
Month
-
Day
Year
Date
Return Time
*
Hour Minutes
AM
PM
AM/PM Option
Transportation
*
Destination
*
Purpose of Trip/Activity
*
List student(s) involved (alphabetized: Last name, First name)
*
Possible Risks - Potential hazards may include but are not limited to the following:
*
Cabin use/cooking – burns from woodstove, camp stoves, or cooked food; falling off ladder or bunk; cuts from hatchets,knives, or camping implements, insect bites or stings.
City – traffic hazards; separation from group; unwanted approaches from strangers
Driving – motor vehicle accidents or injuries
Hiking – injuries sustained hiking on uneven and/or unstable ground; falling from heights, footbridges, or tripping; fallingrocks or trees; hostile wildlife, cuts or abrasions from sharp sticks and rocks; hypothermia, dehydration, exhaustion
Lakes and Rivers – drowning, falling into creeks, injuries from being swept downstream, hypothermia or illness fromcontaminated water, possibly small bruises or blisters
Weather – lightning, hail, debris from wind, water, or flooding, warm and cold temperatures, remote chance of mudslidesor avalanches
Athletic Event – broken limbs, concussion, soft tissue injuries, dental injuries, bruises
Other - Note below
Please note other possible risks not mentioned above.
Trip #5 Sponsors/Volunteers
*
Departure Date
*
-
Month
-
Day
Year
Date
Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Return Date
*
-
Month
-
Day
Year
Date
Return Time
*
Hour Minutes
AM
PM
AM/PM Option
Transportation
*
Destination
*
Purpose of Trip/Activity
*
List student(s) involved (alphabetized: Last name, First name)
*
Possible Risks - Potential hazards may include but are not limited to the following:
*
Cabin use/cooking – burns from woodstove, camp stoves, or cooked food; falling off ladder or bunk; cuts from hatchets,knives, or camping implements, insect bites or stings.
City – traffic hazards; separation from group; unwanted approaches from strangers
Driving – motor vehicle accidents or injuries
Hiking – injuries sustained hiking on uneven and/or unstable ground; falling from heights, footbridges, or tripping; fallingrocks or trees; hostile wildlife, cuts or abrasions from sharp sticks and rocks; hypothermia, dehydration, exhaustion
Lakes and Rivers – drowning, falling into creeks, injuries from being swept downstream, hypothermia or illness fromcontaminated water, possibly small bruises or blisters
Weather – lightning, hail, debris from wind, water, or flooding, warm and cold temperatures, remote chance of mudslidesor avalanches
Athletic Event – broken limbs, concussion, soft tissue injuries, dental injuries, bruises
Other - Note below
Please note other possible risks not mentioned above.
Trip #6 Sponsors/Volunteers
*
Departure Date
*
-
Month
-
Day
Year
Date
Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Return Date
*
-
Month
-
Day
Year
Date
Return Time
*
Hour Minutes
AM
PM
AM/PM Option
Transportation
*
Destination
*
Purpose of Trip/Activity
*
List student(s) involved (alphabetized: Last name, First name)
*
Possible Risks - Potential hazards may include but are not limited to the following:
*
Cabin use/cooking – burns from woodstove, camp stoves, or cooked food; falling off ladder or bunk; cuts from hatchets,knives, or camping implements, insect bites or stings.
City – traffic hazards; separation from group; unwanted approaches from strangers
Driving – motor vehicle accidents or injuries
Hiking – injuries sustained hiking on uneven and/or unstable ground; falling from heights, footbridges, or tripping; fallingrocks or trees; hostile wildlife, cuts or abrasions from sharp sticks and rocks; hypothermia, dehydration, exhaustion
Lakes and Rivers – drowning, falling into creeks, injuries from being swept downstream, hypothermia or illness fromcontaminated water, possibly small bruises or blisters
Weather – lightning, hail, debris from wind, water, or flooding, warm and cold temperatures, remote chance of mudslidesor avalanches
Athletic Event – broken limbs, concussion, soft tissue injuries, dental injuries, bruises
Other - Note below
Please note other possible risks not mentioned above.
Date of Request
*
-
Month
-
Day
Year
Date Picker Icon
Submit
Should be Empty: