We derive the Hamiltonian for trilayer moir\'e systems with the Coulomb interaction projected onto the bands near the charge neutrality point. Motivated by the latest experimental results, we focus on the twisted symmetric trilayer graphene (TSTG) with a mirror-symmetry with respect to the middle layer. We provide a full symmetry analysis of the non-interacting Hamiltonian with a perpendicular displacement field coupling the band structure made otherwise of the twisted bilayer graphene (TBG) and the high velocity Dirac fermions, and we identify a hidden non-local symmetry of the problem. In the presence of this displacement field, we construct an approximate single-particle model, akin to the tripod model for TBG, capturing the essence of non-interacting TSTG. We also derive more quantitative perturbation schemes for the low-energy physics of TSTG with displacement field, obtaining the corresponding eigenstates. This allows us to obtain the Coulomb interaction Hamiltonian projected in the active band TSTG wavefunctions and derive the full many-body Hamiltonian of the system. We also provide an efficient parameterization of the interacting Hamiltonian. Finally, we show that the discrete symmetries at the single-particle level promote the $\mathrm{U} \left( 2 \right) \times \mathrm{U} \left( 2 \right)$ spin-valley symmetry to enlarged symmetry groups of the interacting problem under different limits. The interacting part of the Hamiltonian exhibits a large $\mathrm{U} \left( 4 \right) \times \mathrm{U} \left( 4 \right) \times \mathrm{U} \left( 4 \right) \times \mathrm{U} \left( 4 \right)$ symmetry in the chiral limit. Moreover, by identifying a new symmetry which we dub spatial many-body charge conjugation, we show that the physics of TSTG is symmetric around charge neutrality.