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Colchester Public Schools
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. If applicable, the Board of Education reviews and makes the final decision.
Today's Date: 2/7/27-
indy Aaisner SSS Method of Transportation: e Na a Bus
School: Ghooss School acs n Bus Service Number(s) (if applicable):
Grade(s) and Group(s): 9-19 Kobotits Cub Number of Students: La (4 FRIDAY )
Date(s) of Trip: Marth Ge 1G, ~20, 2022. Number of Day(s) of Trip: 3
Event! FIKST Robotics Competthon Event
| Destination: WeSiern NeEWEn land Univ. Phone Number:
Alumni Heathful Living Center
- a ;
Address /2I5 Wilbraham RA state: 444
(for each destination): SprinaBh ‘el Py, ; MA
Time of Departure From School: Special Clothing and/or Equipment Required:
Time of Arrival Back at School: Club ln form i Robonhcs fqurp ment
Student Cost Information
*Cost to Student: $ Oo Suggested Student Pocket Money: $ 4S
Supervision Information (List names of al Cu MeN Sees leer Sse ACR eM Leia leet)
1. Name: Indy Eraishner Cell Phone:
2. Name: Ajan! Mocksfreld Cell Phone:
List all adult chaperones: 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)
See Attached List
CCL 4 ely RIE OCS
Administrator’s Signature wo 4 Recommended | Not Recommended”
| Recommended [| | Not Recommended
| Recommended Not Recommended
Sti Information
Bus Reservation Date: : nue s | Price of Bus(es): $
Field Trip Cost Form
Date(s) of Trip:
Math) 15 — AO) POPA
Event: L7KST Kobonies Compenten Event
M&J Bus(es) ONLY
Number of Students: Estimated Hours for trip: Fes; Hem— /opr
5 SoRESUN (Add 1 hour pre/post trip) SAT Tarn — wm
FRIDAY
+ 1/0 mentors Fam — bpm
tr mentor (s) Number of Buses: SUN ae
Per Student Calculations: ( ‘
\M&J Bus(es) ONLY ? — Coach Bus(es) ONLY
See OHeete ol bus
Miscellaneous Fees per student: Po ues = 2 (7[ 2 2
Total admission and miscellaneous fees:
Admission per student:
Cost of Bus
Total Field Trip *Cost per Student: QD
Additional Costs:
Number of Substitute Teachers NA
Rate per Day
Special Education costs NA
Cost Associated if Nursing Required NA
Total *Cost to District:
Total *Cost of Trip:
Alternate funding for trip provided by: AwsvD247S/NG / CORPORATE SPINSORS HD
*Insert these costs on the accompanying Field Trip Application
Form updated 5.27.21
Field Trip Instructional Plan
Colchester Public Schools
Field Trip Location(s): Western New England Vv
Reference Check: Visited site on:_NA or Spoke with: Sct Up th ro ughie TEST
Name: Condy Falener GradelGroup:_772/Kphoncs
ippebeds) completing this form) Clie
Instructional Focus of Tri
e This field trip is directly related to curriculum Yes [Sno
e Curriculum Unit(s):
e 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: Approved Denied
Department Chair (High School Only) Date
2fifr Approved Denied
Principal Date
peeved Denied
Director of Teaching and Learning Date
Bacon Academy Robotics Team 1699
FIRST Robotics Competition Event 1
March 18-20 Western New England University District Event
March 18- Pit Set-Up
Roadie Group of 4 students and 4 mentors will travel to Western New England
University to set up the pit in preparation for competition. Leave Bacon at 4:00 pm and
travel to WNE competition site for pit set up from 5-9:00 pm. Group will return to Bacon
Academy for parent pick up at 10 pm.
March 19- Team Travel to WNE
Students and mentors leave Bacon Academy at 7 am for WNE competition site. Pit
opens at 8 am and closes at 8 pm. Bus will transport all back to Bacon Academy for a 9
pm pick up by parents. Lunch will be provided by the team on site and the bus will stop
for dinner on the way home.
March 20- Team Travel to WNE for Day 2 of Competition
M and J bus will pick students and mentors up at 7 am from Bacon Academy and
transport them to WNE competition site. Pit opens at 8 am and closes at 7 pm. Bus will
transport all back to Bacon Academy for a 8 pm pick up by parents. Lunch will be paid
for by the team on site and the bus will stop for dinner on the way home also paid for by
the team.
Supervision Information:
Tom Praisner
Cindy Praisner
John L Spaulding
Alan C Mocksfield
Jason Belding
Seth Crampton
Sharon Cyboron
Glenn Leaman
Dustin Paquette
Bradley Graham
Jonathan Maurice
Mark Noniewicz
02/07/2022 12:SSM&J Bus Colchester
C_ Orore/ ky DK OR BUS TO STAY:
(FAX)860 S37 2628 P.003/003
02-07 22 10:46 FROM- 1-263 P0003/0003 F-051
KribrhicsS
M & J BUS INC. IIe, 34, 3/28
TRANSPORTATION REQUEST FORM
PLEASE USE THIS FORM TO REQUEST BUS TRANSPORTATION, ALL ORDERS BEING PAID BY COLCHESTER PUBLIC
SCHOOLS MUST BE ACCOMPANIED BY A PURCHASE ORDER. CALL FOR A PRICE QUOTE. FILLIN THE FORM
BELOW AND FAX IT TO OUR OFFICE AT 860-537-2625, PLEASE SIGN THE FORM AS YOUR APPROVAL TO BOOK
THE TRIP AT THE QUOTED PRICE. WE WILL THEN BOOK THE BUS AND RETURN A SIGNEO COPY BY AN M&J
EMPLOYEE TO LET YOU KNOW WE RECEIVED THE ORDER, PRICES ARE SUBJECT TO CHANGE IF THE TIMES OR
DESTINATION OF THE TRIP IS CHANGED IN ANY WAY.
BILLING TIME IS % HR BEFORE DEPARTURE TIME AND CONTINUES THROUGH % HR AFTER RETURNING TO
DEPARTURE POINT,
TODAYS DATE: 2| 7 | L225
PERSON PLACING ORDER: Susen US bier nee
SCHOOL OR CS z\ 53 5 = a 5
PHONE NUMBR:
NUMBER OF BUSES REQUESTED: One ( (5 Sthel ants 5
TRIP batt. 20) TRIP PICKUP TIME: 7A
PICKUP LOCATION: GCon Atoaleitag@
vestination: MME bel 1215 NilbrehorlRel Spr ringfie id CT
TIME LEAVING DESTINATION: 7 pM
scram nee) AT PICK UP: _§ PM
ee gene ent (4 HR MINIMUM FOR DROP & PICK / 2 HR MINIMUM FOR BUS TO STAY)
“NOTE ~(M & J BUS INC. RESERVES THE RIGHT TO REFUSE TO DO TRIPS AS DROP-OFFS &
PICK UPS BASED ON THE LOCATIONS AND TIMES. b Up Y |, / Whe
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS TRIP tS: —_/ SO bl
PURCHASE ORDER #:
OR C.0.D se 2 2/7, 22
M & J BUS INC. AND ITS EMPLOYEES ARE NOT RESPONSIBLE FOR ANY ITEMS LOST, STOLEN, OR LEFT ON
BUS.
TO RESERVE ax) aps FOR THIS TRIP, PLEASE SIGN, DATE, AND FAX BACK TO US AT 860-537-2625
IF YOU HAVE ANY QUPSTIONS, PLEASE CALL GREG CORDOVA @ 860-537-2622.
/ )
SIGNATUR' DATE: 2/7/22
CONFIRMATION SIGNATURE (M & J BUS INC)
SIGNATURE: DATE:
02/07/2022 12:S4M&J Bus Colchester (FAX)860 537 2625 P,.001/003
02-07- 22 10:46 FROM- 7-253 P0001 /0003 F-061
ubrics
M & J BUS INC. Iie, 3/19, 3/26
TRANSPORTATION REQUEST FORM
PLEASE USE THIS FORM TO REQUEST BUS TRANSPORTATION. ALL ORDERS BEING PAID BY COLCHESTER PUBLIC
SCHOOLS MUST BE ACCOMPANIED BY A PURCHASE ORDER. CALL FOR A PRICE QUOTE. FILLIN THE FORM
BELOW AND FAX IT TO OUR OFFICE AT 860-537-2625. PLEASE SIGN THE FORM AS YOUR APPROVAL TO BOOK
THE TRIP AT THE QUOTED PRICE. WE WILL THEN BOOK THE BUS AND RETURN A SIGNED COPY BY AN M8
EMPLOYEE TO LET YOU KNOW WE RECEIVED THE ORDER, PRICES ARE SUBJECT TO CHANGE IF THE TIMES OR
DESTINATION OF THE TRIP IS CHANGED IN ANY WAY.
BILLING TIME IS % HR BEFORE DEPARTURE TIME AND CONTINUES THROUGH % HR AFTER RETURNING TO
DEPARTURE POINT.
TODAYS DATE: a | 7 | 2)
PERSON PLACING ORDER: SUSeN US Lier note
SCHOOL OR ORGANIZATION, B A
PHONE NUMBR: g) 537 = LAT b
NUMBRE OF BUSES REQUESTED: one, (4 Sholyts )
TRIP DATE: 3/8) 22) _ ae PICKUP TIME: 4PM
PICKUP LOCATION: Bees n ACode tg
nesrwation: WNE bat, 1215 Vil broharRel Springfield CT
TIME LEAVING DESTINATION: Q Pé
TIME BUS.WILL ARRIVE BACK AT PICK UP: _|lo PM
wr —_— , , _
“ OR BUS TO STAY. ay As
PICK UPS BASED ON THE LOCATIONS AND TIMES. £.
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS TRIP IS:
PURCHASE ORDER #: OR €.0.D.
M & J BUSINC. AND ITS EMPLOYEES ARE NOT RESPONSIBLE FOR ANY ITEMS LOS}/STOLEN, OR LEFT ON
BUS.
TO RESERVE THE BUS/ES FOR THIS TRIP, PLEASE SIGN, DATE, AND FAX BACK TO US AT 860-537-2625
IF YOU HAVE Ay IONS, PLEASE CALL GREG CORDOVA @ 860-537-2622.
DATE: 2[1/22
CONFIRMATION SIGNATURE (M & J BUS INC)
SIGNATURE: DATE:
02/07/2022 12:SSM&J Bus Colchester
C
" PICK UPS BASED ON THE LOCATIONS AND TIMES. By,
(FAx)860 $37 2625 P 002/003
02-07 22 10:46 FROM- T-253 P0002/ 0003 F-051
Kibrics
M & J BUS INC. fig 3/14, 3/26
TRANSPORTATION REQUEST FORM
PLEASE USE THIS FORM TO REQUEST BUS TRANSPORTATION, ALL ORDERS BEING PAID BY COLCHESTER PUBLIC
SCHOOLS MUST BE ACCOMPANIED BY A PURCHASE ORDER. CALL FOR A PRICE QUOTE. FILL IN THE FORM
BELOW AND FAX IT TO OUR OFFICE AT 860-537-2625. PLEASE SIGN THE FORM AS YOUR APPROVAL TO BOOK
THE TRIP AT THE QUOTED PRICE. WE WILL THEN BOOK THE BUS AND RETURN A SIGNED COPY BY AN M&d
EMPLOYEE TO LET YOU KNOW WE RECEIVED THE ORDER, PRICES ARE SUBJECT TO CHANGE fF THE TIMES OR
DESTINATION OF THE TRIP IS CHANGED IN ANY WAY.
BILLING TIME {S % HR BEFORE DEPARTURE TIME AND CONTINUES THROUGH % HR AFTER RETURNING TO
DEPARTURE POINT.
TODAYS DATE: oh | 7 | 222
PERSON PLACING ORDER: SUS en Uc hier nw
SCHOOL OR ORGANIZATION. BA
PHONE NUMBR: ( g) 5S [- LAT 0
muMegE F BUSES REQUESTED: One (15 stdents )
TRIP oe lame PICKUP TIME: 1 AM :
PICKUP LOCATION: Beds n Acaden.g: “—
DESTINATION: WE lini V, ta 5 Wi IbrehailRd Spr gfe id CT
TIME LEAVING DESTINATION: SPM
TiMEs B\S.WILL ARRIVE BACK AT PICK UP: GPM
DROP-OFF ey PICK-U OR BUS TO STAY: a
___spnnsie —— (4 HR MINIMUM FOR DROP & PICK / 2 HR MINIMUM FOR BUS TO STAY)
*NOTE—M & J BUS INC. RESERVES THE RIGHT TO REFUSE TO DO TRIPS AS DROP-OFFS &
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS TRIP IS: ——4s
PURCHASE ORDER #: —____ OR €,0.D.
M & J BUS INC. AND (TS EMPLOYEES ARE NOT RESPONSIBLE FOR ANY ITEMS LOST, STOLEN, OR LEFT ON
BUS.
TO RESERVE THE BUS/ES FOR THIS TRIP, PLEASE SIGN, DATE, AND FAX BACK TO US AT 860-537-2625
IF YOU HAVE! N) QUESTIONS, PLEASE CALL GREG CORDOVA @ 860-597-2622.
SIGNATUR pate: 2/7) 2 27
CONFIRMATION SIGNATURE (M & J BUS INC)
SIGNATURE: DATE: