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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. \f applicable, the Board of Education reviews and makes the final decision.
ie Date: q he loa
_ Field Trip Information
Applicant Name: Ly nn Goodin Method of Transportation: Bus
School: Cheese-Seheol \W Ty TAS Bus Service Number(s) (if appiicabie):
Grade(s) and Groups}: Stn bn f Cy rush f Number of Students: 50
Date(s) of Trip: « Number of Day(s) of Trip:
(s) p Aol 14, 2023 y(s) ip: |
Event: .
Broadway nusical + lunch in NYC
loan Pini Phone Number:
New Yovie 5bo -811- 1806
Address State:
{for each destination): Jd west 51s St. NY N yY
Time of Departure From School: 7:00 AW Special Clothing and/or Equipment Required:
Time of Arrival Back at School: Pag Bo OM
Student (eters a Tella : : oe oe
*Cost to Student: $ 15 0.60 Suggested Student Pocket Money: $ ! 0. wD
Supervision atcha on ce names of al ae : i tier ther ones: and cell shoe hun number ce a a ' : :
1. Name: Lunn Gopdtuin Cell Phone: S40 - 334 - Gall
2. Name: Kere Movyissette. Cell Phone: hp - 303-7777
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)
There will be 5 Teacherl pote profiaionet nn on this ade
Cree: Signatures :
Applicant Signature
Ke
Recommended Not Recommended
Recommended Not Recommended
| Recommended Not Recommended
| Price of Bus(es): $
Bus Reservation Date:
*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
Field Trip Instructional Plan
Colchester Public Schools
Field Trip Location(s): Broadus +ttard Rock (fe NYC
Reference Check: Visited site on: o or Spoke with: “fosh Dow ™M Silver Mitt
Name:_ Lunn Gord Grade/Group: @7* Cherus +Raad
(Teacther(s) completing this form)
Instructional Focus of Trip
—
“1 Yes No
© This field trip is directly related to curriculum
¢ Curriculum Unit(s): Units | 2 aud 7
e Specific Curriculum Standards Addressed by Field Trip (please refer to CT Core and disciplinary standards);
HAE G, PvE Me Enl0-0-6.6 Call.0.€ Fo
Pr4.Z€.jN\e Peo-VEWh Belt. E8o
PrS.A.E Me Reg.r.€.50 Ce7a£ &
e Assessment of Student Learning (describe or attach the work students will complete upon their return to
convey the learning):
Students in Carr will be perferming excepts Srow Hu musica wicked. |
will read a history oe rndead + Cruplete o wrt Hoa assessment
ne, Seting tye live pertivnanee. will Trew choose + Implomtat
wher eho who thear Owe pen . Sdeuts in bard vill
tue p
2! a Swuilar aSsessement 6 it avdksatra .
Trip Agenda/Activities: List/attach entire break out of times for each day. Inciude travel time and all activities.
Attach additional sheet if needed.
DATE/TIME LOCATION ACTIVITY
700 WwW iving 40 N
1190 Lunch at Her lon
: wi ok
7:00 rest sb i Anner
3b pm | WwW ON 6K
Approvals: . Approved Denied
Department Chair (High School Only) Date
a
~~
LA Fo LEZ 0.2. <TApproved Denied
Principal Date
Approved Denied
Director of Teaching and Learning Date
Undated 5.27.21
- Field Trip Cost Form
Date(s)'of Trip: 4 [19 [2 02.3
Event: “Br aduraty Be lol Ine
M&J Bus(es) ONLY
Number of Students: Estimated Hours for trip:
(Add 1 hour pre/post trip)
Number of Buses:
a
Per Student Calculations: No
M&J Bus(es) ONLY oach Bus(es)
Admission per student: \
Miscellaneous Fees per student: wi /
Total admission and miscellaneous fees: \
Cost of Bus
Total Field Trip *Cost per Student:
Additional Costs:
Number of Substitute Teachers |
Rate per Day
Special Education costs
Cost Associated if Nursing Required
Total *Cost to District: j Su b
Total *Cost of Trip:
Alternate funding for trip provided by:
*Insert these costs on the accompanying Field Trip Application F dated $27.21
‘orm updated 5.27,