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pos ry D/r6 /25
Colchester Public Schools
es Application for Approval of Field Trip
Overview : This Form must be completed by all staff to request approval of a
Directions
41. Complete the form with all applicable documentation ‘and submit to your Department Head (BA only) and your Admini!
The Form must be submitted at least 2 weeks prior to the Field Trip for In-State Trips and 10 weeks prior to the Field
2. If approved by your Administrator, the form must be sent to the Assistant Superintendent for approval.
3. If approved by the Assistant Superintendent, the form will be sent to the Superintendent for approval.
4. lf the Trip is Out-of-State, it will be brought to the Board of Education at their next scheduled Meeting for approval and final decision.
Instructional Focus
Is this Trip directly related to curriculum? = Ge - [care Unit :
Field Trip Information.
Applicant Name : Nicole. Steen © Menge Method of Transportation Scfhroa/ ake S-
School: 2A Bus Service Number :
Grade(s) & Group(s): Senior Clakt Number of Students: © [40
Date(s) of Trip: M ay 30 Qo0as” Number of Day(s) of Trip : {
Event: Senior C@ass “Tai
Destination: ‘la Ac Eilat WI |PhoneNumber: Few # SG6- 7G35 -779G)
Destination Address: Point JuolWAyt —_|state:
Time of Departure from School: G/1J7am SA one aumento Required :
Time of Arrival to School: 9/30 yore Be weathn, FUnsenery,
Student Cost Information
*Cost to Student $ py Suggested Student Pocket Money $
Supervision Information i
1.Name: Micode SF Kepac_ CellPhone: “AI¥~ 499-5 SY e4
2.Name: fHaghan Leanne. CellPhone: POG * B8Gl- SIH
List all Adult Chapefdnes: 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 (1 day trips) or 1:10 (overnight trips)
res @ la Lett
Administrator Signatures
Applicant “WA ! Date Dhia fas
Department Chair (BA Only) Un ULV. Date Approved Denied
Principal/Administrator GG Ane Ce pe Date AY pofys- Denied
G 444
Assistant Superinjerdent_ ; Date HA? Y, Approved. ) Denied
Superinten ; __. Date Lf 23 7: a Denied
Board-of Educhtion (if applicable) ~ OR ee
Board of Education Meeting Date Approved Denied
Page 1 Updated October 2024
Field Trip Instructional Plan
Field Trip Location: Sfgck Dilank BE
Reference Check: Visited SiteOn: ™ ZA4 FOIA OR Spoke with:
Name of Staff Completing Form : Nicole at btorgyey & Mea tttn Lrhok
v
Grade / Group Attending : Senta? Chara Pry
Instructional Focus of Field Trip
Specific Curriculum Standards Addressed by Field Trip:
Assessment of Student Learning:
Trip Agenda/Activities
List/Attach entire break out of times for each day. Include travel time and all activities
Date/Time Location Activity
CYT Baum Arnv’: © BA
621 Liat BA-
30 @ how wk + Phdheh 2O
lo-&6 Gr Bloe sland Wulhe check
2 Fens os RIO
6 gm get mn heel
1-Fep | @ BA.
Bus Information —
Bus Reservation Date Price of Bus(es) $
Page 2
Updated October 2024
01-06-25 08:48 FROM- T-089 P0002/0002 F-263
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 M&J
EMPLOYEE TO LET YOU KNOW WE RECEIVED THE ORDER. PRICES ARE SUBJECT TO CHANGE IF THE HIMES OR
DESTINATION OF THE TRIP IS CHANGED IN ANY WAY.
BILLING TIME IS %HR BEFORE SOON AND CONTINUES THROUGH HR AFTER RETURNING TO
DEPARTURE POINT. Wine | Sygate
Cs sie in ant we Ss
ze qnt Ce ; e
TODAYS DATE: epee 2 j2/25 of 2 be
PERSON PLACING oRoER mM belive
SCHOOL OR ORGANIZATION: Baton Peadevny dass of 24
PHONE NUMBR: —_2WQ Se) $Aa24 ee
NUMBER OF BUSES REQUESTED: 2 ISb Shuts
yep vate: .2)20 | 25 ___TRIP PicKUP TIME: _(O.GUYV)
PICKUP LOCATION: YM) —
DESTINATION: AY) ave nd ed v A pet, RE
fe ,
TIME LEAVING oesinanios 2 Bp (pice Youn 27)
TIME BUS WILL ARRIVE BACK AT a 9120 pve (ack. o£ \acon) .
DROP-OFF / PICK-UP: . OR BUSTO STAY:
{4 1HR MINIMUM FOR DROP & PICK / 2 HR MINIMUM FOR
@NOTE—M & J BUS INC, RESERVES THE RIGHT TO REFUSE TO DO TRIPS
PICK UPS BASED ON THE LOCATIONS AND TIMES,
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS TRIP IS: £592.90 x3 fed
PURCHASE ORDER #: ORC.O.D. NS /
. * an “
Mi &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
IF YOU ead LEASE CALL GREG CORDOVA @ 860-537-2622.
SIGNATURE: SAL 2 DATE: 22 LD
CONFIRMATION SIGNATURE (M & J BUS INC)
USTO STAY)
DROP-OFFS &
SIGNATURE: __. DATE:
MEMORY TRANSMISSION REPORT
TIME 02-12-2025 09:43
FAX NO.1
NAME
FILE NO. 2 294
DATE 02.12 09:42
TO :B 8605372625
DOCUMENT PAGES : 4
START TIME 02.12 09:42
END TIME : 02.12 09:43
PAGES SENT : 1
STATUS : OK
***SUCCESSFUL TX NOTICE***
O1-O6—" 25 08:48 FROM—
. T-O89 + PpOCO2/0002 F—-263
TRANSPORTATION REQUEST FORM
PLEASE USE THIS FORM TO REQUEST BUS TRANSPORTATION. ALL ORDERS BEING PAID BY COLCHESTER PUBLIC
SCHOQLS 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 FIMES OR
DESTINATION OF THE TRIP IS CHANGED IN ANY WAY.
BING TIME IS % HR BEFORE DEPARTS ENME AND CONTINUES THROUGH 34 HR AFTER nee TO
‘DEPARTURE POINT. a
: et Ook By coco
‘TODAYS DATE: abe ee quee= a2 {2 f £2. => Sense, pus]
PERSON PLACING ORDER!
Srinkea
scyo OAL. OR ORGANIZATION:
Badems Pcaclewwy Wass of 2
PHONE NUmBR: —__iz@ BG) SA2 A :
NUMBER OF BUSES REQUESTED: Bo (50 ~hesli STS
TRIP DATE: 2 =z
TRIP PICKUP TIME: me LO CHAN
Pickur LocArion: _ZACON Arcacko yrtey
DESTINATION:
Mantddeen ants Gvedk Island est nanagansct. RE.
TIME LEAVING prsnnaTioke NP S212 CRrcle_c 42 ye-T)
-FB0 pin C bck. at Vaan).
OR BUSTO STAY: rn
(BR MINIMUM FOR DROP & PICK / 2 HR MINIMUM FORAY STAY)
NOTE — Mi & J BUS INC. RESERVES THE RIGHT TO REFUSE TO DO TRIPS ROP-OFFS &
PICK UPS BASED ON THE LOCATIONS AND TIMES: #
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS ‘(RIP IS: AEE LOK 2 e14—
PURCHASE ORDER #: OR C.0.B.
iM & 5 BUS INC. AND ITS EMPLOYEES ARE NOT RESPONSIBLE FOR ANY ITEMSLOST, STOLEN, OR TEFT ON
Bus.
TO RESERVE THE
JF YOU HAVE Al
TIME BUS WILL ARRIVE BACK AT BICK UP:
DROP-OFF / PICICUP:
= =
SIGNATURE: DATE: 22 L122
CONFIRMATION SIGNATURE (M & J BUS INC}
SIGNATURE: