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SignaturePrint NameClass/Group: Number of Participating Students: Teacher/Sponsor Authorization:SignaturePrint NameNumber of Chaperones:(One chaperone per 10 һƵs)Names of Chaperones:  Destination: Overnight Stay: FORMCHECKBOX  Yes  FORMCHECKBOX  NoTime of Departure:Dates of Travel:Time of Return:Mode of Travel:  Cost paid by the һƵs: $ Per һƵCost paid by district:$ Budget Source Code:Other cost paid by (choose one :) FORMCHECKBOX  Activity fund  FORMCHECKBOX  Booster club FORMCHECKBOX  һƵ organization FORMCHECKBOX Other: FORMTEXT      $ FORMTEXT       Educational Objectives:  Itinerary:  Students names, parents/guardians names, addresses, home and work telephone numbers (to be submitted to the appropriate assistant superintendent s office prior to travel) Proof of .;<JKLYZhij{| ѮћшрugcTgFhPR2CJOJQJ^JaJhPR25CJOJQJ^JaJhPR2hPR2CJOJQJ^JaJhPR25CJOJQJhPR2CJaJ$j-hPR25OJQJUaJ$j2-hPR25OJQJUaJ$j,hPR25OJQJUaJjhPR25OJQJUaJhPR25OJQJaJhPR2CJ OJQJaJ jhPR2OJQJUaJhPR2OJQJaJ./Mkdb\$Ifkd.$$IflLF!7*w0*    4 laL$If]L^$If {{{{($$d%d&d'dIfNOPQUkd.$$IfH0)0# tB*6"44 Ha$If    }}}}$If{kd1/$$IfH\{ e) Fq tB*6"44 Ha  ) * M N }}}}$If{kd/$$IfH\{ e) Fq tB*6"44 Ha  ) * M N O p q r       & ūş}iRii,j>4hPR25CJOJQJU^JaJ&jhPR25CJOJQJU^JaJhPR25CJ OJQJaJ hPR25CJOJQJhPR2OJQJ^JhPR2CJOJQJ^JhPR2CJOJQJ^JaJhPR2OJQJ^JaJhPR25CJOJQJ^JaJhPR2CJaJ hPR2aJhPR2CJOJQJ^JaJhPR25CJOJQJ^JaJN O n o p q }}}}$If{kdo0$$IfH\)/  L  tB*6"44 Haq r s } ~ }}}}$If{kd1$$IfH\ e)  q tB*6"44 Ha }}}$If{kd1$$IfH\ e)  q tB*6"44 Ha MBkd2$$Ifl/)B* tB*644 la$IfhkdZ2$$IfHF @)& d tB*6"    44 Ha sqBkd3$$Ifl/)B* tB*644 la$IfBkd53$$Ifl)B* tB*644 la , ? @ $$Ifa$Skd3$$IfH0T*f6$ t*644 Ha& ' ( ? @ R S c d v w x z {     ! " 0 ƹƹƬ~lWll)j8hPR2CJOJQJU^JaJ#jhPR2CJOJQJU^JaJhPR25CJ OJQJaJ hPR25CJOJQJhPR2CJaJhPR2CJOJQJ^JaJhPR25CJOJQJaJhPR25CJOJQJaJhPR25CJOJQJ^JaJ&jhPR25CJOJQJU^JaJ,j4hPR25CJOJQJU^JaJ@ A R S c d $Ifykd&5$$IfH\d T*P\ 4 t*644 Had e v w x +SkdV6$$IfH0T*# t*644 Ha$Ifykd5$$IfH\d T* 4 t*644 Hax { {{kd6$$IfH\ [* M t*644 Ha$If ! @ g pjjjj$Ifkd`7$$IfHrd A[*ia  t*644 Ha0 1 2 @ A O P Q i j x y z    ( * , 6 8 : < ʵʠʔ}gʔXgj:hPR2CJUaJ*jhPR2CJOJQJUaJmHnHujs:hPR2CJUaJhPR2CJaJjhPR2CJUaJ)j9hPR2CJOJQJU^JaJ)j8hPR2CJOJQJU^JaJhPR2CJOJQJ^JaJ#jhPR2CJOJQJU^JaJ)j8hPR2CJOJQJU^JaJg h i   : zzzzz$If~kdm9$$IfH4\K k [*`    t*644 Haf4: < > p mke$Ifkd_;$$IfH4rK k v![*  7  t*644 Haf4< > v x @ <}<~<<< ====˽˝ˏvhPR25CJOJQJhPR2CJOJQJ^JaJh'CJOJQJ^JaJhPR26CJOJQJ^JaJUhPR25CJOJQJ^JaJhPR2CJOJQJ^JaJhPR2OJQJ^JhPR25CJ OJQJ^JaJ hPR2CJOJQJ^JaJhPR25CJ OJQJaJ p r t v x sqBkd`<$$Ifl/7** t*644 la$IfBkd<$$Ifl/7** t*644 la @ <R<d<z<~<<<<<<<$If`Bkd<$$Ifl/7** t*644 laInsurance for each һƵ: If insurance provided by carrier, list the following: Name of company Amount of insurance (Proof of Insurance is not required for trips inside the һƵ-Metro area.) 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