Offsite Outing Request

Teacher Name:(Required)

First Last

Class:(Required)

Purpose of Trip:(Required)

Is this a recurring outing?

Yes

Destination:(Required)

Pick-Up Location

Mode of Transportation There:(Required)

Mode of Transportation Back:

If other, please specify:

Date(Required)

Departure Time (Please note: Load time is 10-15 mins prior to departure)(Required)

Return Time:

Is there a cost to students?(Required)

Is there a cost to KCC?(Required)

Medical needs during off-site time:(Required)

Will this impact 1:1 therapy, group therapy or integration? Please be specific:(Required)

Parent Notification Plan:(Required)

Additional staff/volunteers:(Required)