Due at least seven (7) BUSINESS days before your trip!!! Please submit this form as soon as you have scheduled and confirmed your event.
Remember NOT to use the ENTER KEY while completing this form.
Club Name:
Person Submitting Form:
Destination (City, State):
Approximate distance to destination:
Type of Activity:
Hosted by (school, National Governing Body, organization):
Departure Date & Time
Depart Date:
Departure Time from W&M:
Returning Date & Time
Return Date:
Return Time to W&M: (Please remember to include time to refuel vehicles if necessary.)
Participant Information
Primary Contact
Primary Contact Cell Phone #: xxx-xxx-xxxx
List first and last names of all participants on this trip: *Separate names with commas or semicolons - please DO NOT hit the ENTER key in between names.
Additional Activity Information
Equipment Requests: Be sure to send your requests directly to the Equipment Center at equipctr@wm.edu . This includes requests for tables & chairs.
Additional Activity Information: For competitions, tournaments, games and scrimmages, please include information if available about the estimated start day/time of your event or competition and list the other schools involved. For socials and meetings, give brief information about the type of social or purpose of the meeting. For fundraisers, describe the nature of the fundraiser and anticipated revenue.
Additional Comments / Notes:
Taking a van or rental vehicle? (IMPORTANT! Van is not reserved without filling out a Form V - Vehicle Request Form and receiving a confirmation.)
Equipment Requests: Send your requests to equipctr@wm.edu
Housing Accommodations
Name of Hotel/Campground/Residence(s), etc:
Phone Number:
Safety Officer/Wilderness Trip Leader Information
Every club travelling must have two Safety Officers, each certified in at least First Aid and CPR. Any club going on a trip in a wilderness context (defined as more than 2 hours from advanced medical care) requires 2 Trip Leaders who are Safety Officers with additional requirements.
Name of Safety Officer 1
Has this individual filled out a Form S, provided copies of certifications showing current certification in First Aid and CPR, and passed the Blackboard Quiz?
Has Safety Officer 1/Wilderness Trip Leader 1 undertaken any trip leader in-service trainings, either through W&M or elsewhere?: If yes, please describe below.
List any training / experience that Wilderness Trip Leader 1 has that makes him / her qualified to lead this trip:
Name of Safety Officer 2:
Has Safety Officer 2/Wilderness Trip Leader 2 undertaken any trip leader in-service trainings, either through W&M or elsewhere?: If yes, please describe below.
List any training / experience that Wilderness Trip Leader 2 has that makes him / her qualified to lead this trip:
Vehicle Information
All individuals driving sport club members to a registered event must be authorized drivers. The College also asks for a list of passengers in each vehicle, to ensure that we have necessary information in the event of an emergency.
Club members CANNOT drive without submitting the {{http://www.wm.edu/offices/recsports/sportclubs/forms/appd/,Driver Authorization Form (Appendix D)}} (View the list of {{http://media.wm.edu/content/wm/recsports/sportclubs/onlineforms/driverauthorizations.xls,authorized drivers}}).
Driver(s) for Vehicle 1:
Has each driver for Vehicle 1 submitted an online Driver Authorization Form?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Will driver(s) for Vehicle 1 be driving a van / rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
List all club members who will be passengers in this vehicle:
Driver(s) for Vehicle 2:
Has each driver for Vehicle 2 submitted an online Driver Authorization Form?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Will Vehicle 2 be a van or rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
Driver(s) for Vehicle 3:
Will Vehicle 3 be a van or rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
Has each driver for Vehicle 3 submitted an online Driver Authorization Form?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Driver(s) for Vehicle 4:
Has Driver 4 submitted an online Driver Authorization Form for the current academic year?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Will Driver 4 be driving a van / rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
List all club members who will be passengers in this driver's vehicle:
Driver(s) for Vehicle 5:
Has Driver 5 submitted an online Driver Authorization Form?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Will Driver 5 be driving a van / rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
Driver(s) for Vehicle 6:
Has Driver 6 submitted an online Driver Authorization Form?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Will Driver 6 be driving a van / rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
Driver(s) for Vehicle 7:
Has Driver 7 submitted an online Driver Authorization Form?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Will Driver 7 be driving a van / rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
Driver(s) for Vehicle 8:
Has Driver 8 submitted an online Driver Authorization Form?: A driver need submit the Driver Authorization Form (Appendix D) only once each academic year, UNLESS circumstances change regarding his/her driver's record.
Will Driver 8 be driving a van / rental vehicle?: Must have taken a W&M Defensive Driving Course to drive any van or rental vehicle
Flight Information
Continue to next section if not flying.
Departing From: (airport, city, state)
Departure Date:
Departure Time: (hh:mm am/pm)
Departing Flight #s (list all):
Returning From: (airport, city, state)
Arriving In: (airport, city, state)
Return Date
Returning Time: (hh:mm am/pm)
Returning Flight #s (list all):
Return Arriving In: (airport, city, state)
