Activity Request Form

*All chaperones must be PCSB approved. Chaperones must remain with the students during the entire trip. All volunteers/chaperones are board approved and all volunteer/chaperones will be promptly reported to the volunteer coordinator. A list of students attending this activity will be either e-mailed to each staff member prior to the activity.
*Bookkeeper and Clinic Initials are needed.
*PO’S must be submitted 48 hours prior to the activity*

Request Submitted By
Your School Email Address
Title of Event
Team Organization
Today's Date Today's Date / MM / DD YYYY
Beginning Activity Date Beginning Activity Date / MM / DD YYYY
End Activity Date End Activity Date / MM / DD YYYY
Beginning Time Beginning Time : HH MM AM/PM
Ending Time Ending Time : HH MM AM/PM
Location of Event
Number of Participating Students
Description of Event
Educational Objective
Revenue Source
Total Cost of Activity
Clinic Needs
Media Needs
Items checked below must be completed BEFORE activity takes place:

Items checked below must be completed BEFORE activity takes place: Field Trip Packet Fund Raiser Packet SRO Needed Custodian Needed/#of Hours FNS Notified of the Event Leave Request
Busses Needed?

Busses Needed? Yes No
Substitute Needed

Substitute Needed Yes No
How many subs are needed and which teacher(s) needs the sub? (If no subs are needed just type n/a)
Custodial Services Needed

Custodial Services Needed Yes No
If yes, please identify all services needed. Attach a diagram if needed.
*Custodial needs must be confirmed with the plant manager prior to the activity.