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6153
In state: TWO (2) weeks prior to trip Application for Approval of a Field Trip : Appendix A
Out of state and/or overnight: Colchester Public Schools

TWO (2) weeks and TWO (2) months prior te Board meeting for BOE approval

 

Schoot Ry CAN Ae. a deans) Date of application: 2| ul a

 

       
 

+) , f
Grade(s) and Group(s) \O Pn J) vo lo 5 Date(s) of Trip: ebrstorg 4/30 po
Method of Transportation: { Sac l 2) B we # of Day(s) of Trip: 71
Bus Service Number(s) (if applicable): Number of Students: H oO

Please keep M&J Bus Co. phone numbers with you during the field trip: 860.537.2622 and cell phone 860.705.0128

event Pry sican Musou of Nata | Hhstory My
“Destination: N y _ Phone NumbenZ-4 2. a ( aA § 2.09
Address: 200 Center [ Py AL W2sr
NOS state VY

Time of departure from school: >, 09 Time arrival back to school)’. Q pm

 

 

Special clothing and/or equipment required:

 

Supervision provided by: (List names of all employees, other chaperones, and cell phone # for each)
Main contact(s) and cell phone number(s) (list one or two people):

4. Names.) 4 | | ANAS LY Cell Phone: Lid- IO ~ vl SS
2. Name: +TRD Cell Phone:

List all adult chaperones: Ratio of adult chaperones to students must be at least: (grades K-2 1:5) (grades 3-5 1:8) (grades 6-8 1:10) (grades 9-
12 one day trips 1:15, overnight trips
1:10)

Mi | Ltnwsster .
Donna Bow A [ othe 40 be CLeterinaya Lied }

 

 

 

 

“if needed: source of scholarship funds:

Solty Ub dupartavret doar dod)

“Cost to Student:$ Suggested Student Pocket Money:$. 0 ~ l C

 

 

Applicant's onan pate = Dept. Chair Signature Qa ean

 

 

Principal’s Signature Date: 2/24/26 [Recommended (] Not Recommended
Superintendent's Stonaturs_£ Z LA {]Recommended [] Not Recommended
if applitable? Board doh Caucaty Educ: Meeting Las {]}Recommended [] Not Recommended

Must be approved by Boatd 2 months prior to out of state and overnight trips

 

 

Bus Reservation Date: Price of Bus(es):

 

 

*If a trip to a foreign country, please compiete and attached the CIRMA insurance application and notify parents of coverage 100918

 

 


 

6153
Appendix B
Field Trip Instructional Plan
Colchester Public Schools

Field Trip Location(s): fmca em Vusevn, 6 Vatey a { Hh tony
Reference Check: Visited site on: or Spoke with: Rogeasrtie Sur Vide 2421

Name: Th Lena Ltna Ser Grade/Group:| oO / ‘Byo | of) y
(Teacher(s) completing this form)

 

 

 

Instructional Focus of Trip
e This field trip is directly related to the curriculum: YES X NO

¢ Curriculum Unit(s): EVO ILA at Popul athons mad

VodivesS} re
e Specific Curriculum Standards Addressed by Fi Yip (please refer to CT Core and
disciplinary standards):

LS 2-2 facto ebferrg biodivasty in eeasystenr
He LS YY Nata! 5 (cote Leadle —te aapit es
5 §~3Rudvuary human mmpacr on nivea |
H Syfe~ c te maintain biddive-s; ty)
° Asse

oe nian) Student Learning: Describe or attach the bork Students will complete upon

ovlAbw of ee Sr dents iw on Act reeearcl
On A nes spelabin of é %% ey gate and Nae alate
at ch ANGEL i" popvey v2l9p meal
pred p Pérkeet Speeies a padi h na lagcliucrsity

 

 

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
OyV

Lew in bl Vv
-\l Viet <pechim

VA | AL +} y
‘ \
sho 12738

2} AK Approved / (1 Denied

Depi nt Chair (High School Only) Date

AL. z/r4/r [Approved /O Denied
Pri PA Date

LJVr afripe @ Approved / 1 Denied

‘SieeCior of Curriculum & Instruction Date

   

Approvals:

Fiefd Trip Instructional Plan 2018 2019.doc