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Colchester Public Schools e d O i ona
Application for Approval of Field Trip OU Lie Ite
Overview: This form must be completed by all staff to request approval of a field trip. i/ 23
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: «JQ 3) 202.43
Applicant Name: indy Fra isner Method of Transportation: Bus
School: Choose Schaol Bus Service Number(s) (if applicable):
Grade(s) and Group(s): q 12./Robph aS Number of Students: lq ( i Thursday)
Date(s) of Trip: Apr | 5- -2 \ as the Number of Day(s) of Trip: pas ‘4
2 4. =
Even }
“FIRST Robohis CompéHhon ( disivict Champs- IE wequaltfy)
Destination: — Phone Number:
BiQkE
Address? 13045 Memorial Awe State:
(for each destination): West son neh eld MA
Time of Departure From School: - See Slyeciu ile. Special Clothing and/or Equipment Required:
Time of Arrival Back at School: Club Uni form /Roloot Ecc p
Student Cost Information
*Cost to Student: $ ©
Suggested Student Pocket Money: $ 5
~
Supervision Information (ist names of all employees, other chaperones, and cell phone number for each)
1. Name: Cindy, Hraisner Cell Phone:
2. Name: 7)M Pred isner 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
| Administrator Signatures
Applicant Signature
Administrator’s Signature
aie (I Not Recommended
Superintendent’s Signature Recommended (| Not Recommended
| Board of Education (if applicable)
Board of Education Meeting Date:
Crd
Bus Reservation Date: Price of Bus(es): S$
“If a trin toa foreien country olease camonlete and attached the CIRMA insurance annlicatinn and notify narante af eavarsaa fact Hndatad 6/97/91
Date(s) of Trip: Any) | 5 ~8
Field Trip Cost Form
Event: FIRST Roboncs Competthin District Champions he PS
M&J Bus(es) ONLY
wep AT BACON AT PIGE
Number of Students: Estimated Hours for trip: ths 3230PM PuxvP 8:00PM
WH 4+ wWeD (Add 1 hour pre/post trip) Biot eee pee
Ghdow 17 THRs Rltimnenereusee SAT @nsAM 400 9M
17 PRA |
vi] SAT
Per Student Calculations:
Admission per student:
Miscellaneous Fees per student:
Total admission and miscellaneous fees:
Cost of Bus
Total Field Trip *Cost per Student:
M&J Bus(es) ONLY Coach Bus(es) ONLY
Additional Costs:
Number of Substitute Teachers
Rate per Day
Special Education costs
Cost Associated if Nursing Required
Total *Cost to District:
Total *Cost of Trip:
Alternate funding for trip provided by:
Corporate Sponsorship
*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): Bid E
Reference Check: Visited site on: Nk or Spoke with:
Name: € indy Ha iene GE Grade/Group: 7-!7_/ Ro bo gS
(Teacher(s) cdmpleting this form)
Instructional Focus of Tri
e This field trip is directly related to curriculum Eh Yes Ase
© 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: [ \apetoved | |Denies
Department Chair (High School Only) Date
Any Clas a [5f23 [Haeetoved [_]penied
Principal 7 ¢ Date
oe Talend [ |peniea
Director of Teaching and Learning
Bacon Academy Robotics Team 1699
FIRST Robotics District Championships
April 5-8 Eastern States Exposition (Big E)
IF TEAM QUALIFIES!
April 5-Pit Set-Up schoo! Van Upon Approve
M and J bus will pick Roadie Group of 4 students and 2 mentors will travel to
Eastern States Exposition to set up the pit in preparation for competition. 1
Mentor will drive separately with trailer. Leave Bacon at 3:30 pm and travel to
competition site for pit set up from 5-8:00 pm. Group will stop for dinner on the
way home and return to Bacon Academy for parent pick up at 10 pm.
April 6- Team Travel to Eastern States Exposition- School Day
M and J bus will pick students and mentors up at 6:15 am from Bacon Academy
and transport them to Big E competition site. Site opens at 7:30 am and matches
end at 6 pm. Bus Pick-up will be 6:00 pm and transport all back to Bacon
Academy for a 9:00 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 also paid for by the
team.
April 7- Team Travel to Eastern States Exposition - School Day
M and J bus will pick students and mentors up at 6:15 am from Bacon Academy
and transport them to Big E competition site. Site opens at 7:30 am and matches
end at 6 pm. Bus will pick up at 6 pm and transport all back to Bacon Academy
for a 9 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.
April 8- Team Travel to Eastern States Exposition
M and J bus will pick students and mentors up at 6:15 am from Bacon Academy
and transport them to Big E competition site. Pit opens at 7:30 am and closes at
4 pm. Lunch will be paid for by the team on site. Bus will pick up at 4 pm and
transport all back to a local Colchester restaurant for dinner paid for by the team.
Parents will pick up from the restaurant at 7:00 pm.
Supervision Information:
Tom Praisner 959 444 1605
Cindy Praisner (860) 705-9765
Alan C Mocksfield 860-949-3292
Jason Belding 860-391-1581
Seth Crampton 860-681-6075
Bradley Graham 860-373-6110
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M &J BUS INC.
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&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: | | 5] 2
PERSON PLACING ORDER: SUSEN MC MOV renee
SCHOOL OR ORGANIZATION: BP \ Ro bots
PHONE NUMBR: ( | S31 2BATK —
NUMBER OF BUSES REQUEsTeD: | __™ 7 Stithe. AS
TRIP DATE: _ Apc | 7 trip PICKUP TIME: —@ ISAM
PICKUP LOCATION: P2acen Academy
pesrination: 1314 E1205 Memorial Ave, West Springhe Id MA
TIME LEAVING DESTINATION: (2°0O PM
TIME BUS WILL ARRIVE BACK AT PICK UP: —Z: pm Si Wg pr dinner
at
DROP-OFF / PICK-UP: OR BUSTO STAY:
(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.
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS TRIP |S:
PURCHASE ORDER #: —-——____ OR C.0.D.
M &J BUS INC. AND ITS 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
IE YOU HAVE ANY QUESTIONS, PLEASE CALL GREG CORDOVA @ 860-537-2622.
SIGNATURE: fone pate: _! | o)Z 2
CONFIRMATION SIGNATURE (M &J BUS INC)
SIGNATURE: DATE:
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