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Colchester Public Schools Shor. boned dan
Application for Approval of Field Trip dust ssa)
Overview: This form must be completed by all staff to request approval of a field trip. at | | : YO
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: 6/1/23
Field Trip Information
Applicant Name: Keith M orrissette Method of Transportation: School Bus
School: WJJMS Bus Service Number(s) (if applicable):
Grade(s) and Group(s): 9+, Grade Band/Chorus Number of Students: 75
Date(s) of Trip: May 94 2024 Number of Day(s) of Trip: 1
Event: ix Flags Trip
Destination: .. Phone Number:
- Six Flags New England (413)786-9300
Address aa: 1623 Main St., Agawam,MA | St CT
Time of Departure From School: 4:45PM Special Clothing and/or Equipment Required:
Time of Arrival Back at School: 9:15PM music tshirt
Sab Te(stah a Gow lal ielauitiaiela)
*Cost to Student: $ $20-$75
SU oletaeEM LLke) atic) 1 (e)8 Meee
1. Name: Keith Morrissette Cell Phone:
2. Name: Lynn Goodwin Cell Phone: ia
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)
Suggested Student Pocket Money: $ $20
Six chaperones will be recruited a month in advance.
Administrator Signatures
Applicant Signature et Woes
4a,
Administrator's Signature (“~~ [=] Recommended [| Not Recommended
[S}xécommended [ ] Not Recommended
Board of Education (it applicable)
Board of Education Meeting Date: | | Recommended [ | Not Recommended
Bus Information
Bus Reservation Date: Price of Bus(es): $
IF atrip toa foreign country, please complete and attached the CIRMA insurance application and notify parents of coverage Last Updated 5/27/21
Field Trip Cost Form
Date(s) of Trip: May 24, 2024
Event: Six Flags Trip
M&J Bus(es) ONLY
Number of Students: Estimated Hours for trip:
(Add 1 hour pre/post trip)
75
Number of Buses: 2
Per Student Calculations:
M&J Bus(es) ONLY Coach Bus(es) ONLY
Admission per student: $ 40
Miscellaneous Fees per student: n /a
Total admission and miscellaneous fees: $40
Cost of Bus TB D
Total Field Trip *Cost per Student: $40+ Bus
Additional Costs:
Number of Substitute Teachers n la
Rate per Day
Special Education costs n la
Cost Associated if Nursing Required n la
Total *Cost to District: 0
Total *Cost of Trip: $20-$75
Alternate funding for trip provided by: M usic Activity Fu nd
*Insert these costs on the accompanying Field Trip Application Form updated 5.27.21
ri ate: dl,