BA Field Trip Application, 10.27.21

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Colchester Public Schools I} al ay LP eel AL
Application for Approval of Field Trip

 

Overview: This form must be completed by all staff to request approval of a field trip.
Directions:

1. Complete the form attaching all applicable documentation and submit to your administrator. The application
must be submitted at least two weeks prior for in-state field trips, and two weeks and two months prior for
out-of-state trips.

2. The Administrator will recommend or not recommend. If approved, the form must be sent to the
Superintendent.

3. The Superintendent will either recommend or not recommend and will bring to the Board of Education if the
request is for an out-of-state field trip.

4. |f applicable, the Board of Education reviews and makes the final decision.

Today’s Date:
Field Trip Information

Applicant Name: Method of Transportation:
Marmne Chen Coacre Rus

 

School: Choose School RB als “A Bus Service Number(s) (if applicable):

 

Grade(s) and Group(s): Camper wo 5 Cd Number of Students: _-/0 dD Finale TRA

 

Date(s) of Trip: o \ \ 21 Wa Number of Davia’ a Trip: L

 

Event: .
Foun Fritenvlein Hue musical
Destination: Phone Number:

Ogunquit “Pleyhouse— aory- bite - AS
dd ‘ x -
Address 1) Wan St. Oqurquat NE State: Me

(for each destination):

 

 

 

Time of Departure From School: . -Od Ay Special Clothing and/or Equipment Required:
Time of Arrival Back at School: 4100 DPM Wore

Student Cost Information
*Cost to Student: $ I5D- ©CO

Supervision Information Meri cartansoneelncanoin giro tolucamesteyevcinolecreets onc) ae nolotcar sel aptolsies Cela ccloigf)
1. Name: Marine Cheney Cell Phone: 2o3- 9er-4are

   
 

      

 

Suggested Student Pocket Money: $ 15200

   

 

 

 

 

 

2._NameFhigyaus Kess Wi Cell Phone: 3U0- UOR- 70/4
List all adult chaperbnes: Ratio of adult chaperones to students must be at least: 1:5 for Grades K-2, 1:8 for Grades 3-5; 1:10 for

Grades 6-8; and 1:15 for Grades 9-12 (one-day trips) or 1:10 (overnight trips)
ee den bollwite
Lisa Kessler

Lynn Goodin Others TRY KM
Marya Mallo
Administrator Signatures

Applicant Signature WY AONK Om

-Administrator’s a Lfecommended Not Recommended
4
; 7 Si.
Superintendent $ Signature / Jif Gy i-Recommended Not Recommended
< Lf
ear of Education i doplicabie)
Board of Education Meeting Date:

     
   
 

 

 

  
 

 

 

 

 

 

 

 

 

  
  
  

  
 

 

 

 

[ ] Recommended Not Recommended

 

   
       

Bus Information

Bus Reservation Date: Price of Bus(es): $

 

 

 

*If a trip to a foreign country, please complete and attached the CIRMA insurance application and notify parents of coverage Last Updated 5/27/21


 

642 0G Sheet

Field Trip Instructional Plan
Colchester Public Schools

Field Trip Location(s):

 

Reference Check: Visited site on: or Spoke with:

Name: Nannne Chern Grade/Group:

(Teacher(s) completing this form) J

Instructional Focus of Trip

e This field trip is directly retated to curriculum [| Yes No

e Curriculum Unit(s):

 

 

 

 

Specific Curriculum Standards Addressed by Field Trip (please refer to CT Core and disciplinary standards):

e Assessment of Student Learning (describe or attach the work students will complete upon their return to
convey the learning):

Trip Agenda/Activities: List/attach entire break out of times for each day. Include travel time and all activities.
Attach additional sheet if needed.

DATE/TIME LOCATION ACTIVITY

 

 

 

Approvals: Ga a 2} ZS Hroved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

> { Denied
Department Chair (High School Only) Date
Ao 9 fas: él UV Approved Denied
Principal Date
approved Denied
biréctor of Tedshing-andLearn earning Date pp

 

 

 

 

 

Undated 5.27.21

 


Field Trip Cost Form
Date(s) of Trip: Derolev ew, TW VM

“HrankunstenJ

M&J Bus(es) ONLY

Event: Mustack : ours

Number of Students: 1 0 oO Estimated Hours for trip:
(Add 1 hour pre/post trip)

Number of Buses: 2)

 

Per Student Calculations:

 

 

M&J Bus(es) ONLY Coach Bus(es) ONLY
Admission per student:
Miscellaneous Fees per student:
Total admission and miscellaneous fees:
Cost of Bus
Total Field Trip *Cost per Student: ¥ | S0-00
Additional Costs:
Number of Substitute Teachers 4
Rate per Day
Special Education costs _—
Cost Associated if Nursing Required —
Total *Cost to District: O
Total *Cost of Trip:
P &_ /Ziovo

Alternate funding for trip provided by: _— «
Tundvasurs + Student Activity Acounct

*Insert these costs on the accompanying Field Trip Application
Panying P APP Form updated 5.27.21