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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. lf applicable, the Board of Education reviews and makes the final decision.
Today's Date:
Field Trip Information
Applicant Name: Mechelle Berardo/Class Advisor | Method of Transportation: 118.) School Bus
School: BA [=] Bus Service Number(s) (if applicable): g69.537-2625 Greg Cordova
Grade(s) and Group(s): Grade 12/ Class of 2022 Number of Students: Approx 170
Date(s) of Trip: Friday June 3, 2022 Number of Day(s) of Trip: 4
Event: Senior Class Trip
Destination:
Newport RI/ Block IslandRI | Pre N#™E BY Ferry 401-783-7996
Address State: R |
(for each destination): Point Judith Ferry, Narragansett RI to Block Island
Time of Departure From School: 6:30 AM Special Clothing and/or Equipment Required:
Time of Arrival Back at School: 10:00 AM Weather Appropriate Attire/ Cool Weather Clothes
Student Cost Information
*Cost to Student: $ Suggested Student Pocket Money: $ 3
37.00 30-50
RU) rai cey a) Information (Seren emu meie te cmea eRe taal msc)
1. Name: Mechelle Berardo Cell Phone:
2. Name: Amy Begue 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)
Matt Lane, David Mason - further chaperones to be determined from BA Staff
Approx 7 more chaperones needed
Administrator Signatures
Applicant Signature YY
Administrator’s Signature
Recommended Not Recommended
Superintendent’s Signature
Recommended Not Recommended
Board of Education (i appiicable)
Board of Education Meeting Date:
ee Recommended Not Recommended
Bus Information
Bus Reservation Date:
Price of Bus(es): $
*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
Block Island, RI
Previous Trips
Field Trip Location(s):
Reference Check: Visited site on: or Spoke with:
Name: Mechelle Berardo Grade/Group: Class of 2022/ Grade 12
(Teacher(s) completing this form)
Instructional Focus of Trip
e This field trip is directly related to curriculum Yes W| No
e Curriculum Unit(s): N/A
e Specific Curriculum Standards Addressed by Field Trip (please refer to CT Core and disciplinary standards):
Not applicable - Senior Class Trip
e Assessment of Student Learning (describe or attach the work students will complete upon their return to
convey the learning):
Not applicable - Senior Class Trip
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
6:00 am Bacon Academy Gather in Auditorium
6:30 am Bacon Academy Depart for RI
9:00 am Point Judith, RI Ferry To Bl
10-7 pm Block Island Activities on BI
7:00 pm Block Island Ferry back to Point Judith, RI
8:00 pm Point Judith Depart for Bacon Academy
9:30 pm Bus Travel Arrive back at Bacon Academy
Approvals: Cie 3/28 | Zot. V| Approved Denied
Department Chair (High School Only) Date i
Yee Hdd ae
fe So 4 Approved Denied
Principal Date
iy
Ci War
C - WA <_ i/ | KO pproved Denied
Director of Teaching and Learning Date
UIndated 5 77 71
Field Trip Cost Form
Date(s) of Trip: Friday June 3, 2022
Event: Senior Class Trip
M&J Bus(es) ONLY
Number of Students: Estimated Hours for trip: 47
(Add 1 hour pre/post trip)
170
Number of Buses: 4
Per Student Calculations:
M&J Bus(es) ONLY Coach Bus(es) ONLY
Admission per student: $22
Miscellaneous Fees per student: $30
Total admission and miscellaneous fees: $52
Cost of Bus $15
Total Field Trip *Cost per Student: $67
Additional Costs:
Number of Substitute Teachers 8
Rate per Day
Special Education costs
Cost Associated if Nursing Required
Total *Cost to District: 0
Total *Cost of Trip: $6300
Alternate funding for trip provided by: S anior Class Dues
*Insert these costs on the accompanying Field Trip Application F dated 52721
orm update wll,
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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 RE ACCOMPANIED BY A PURCHASE ORDEA, 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&
EMPLOYEE TO LET YOU KNOW WE RECEIVED THE ORDER, PRICES ARE SUBJECT TO CHANGE IF THE TIMES OR
DESTINATION OF THE TRIP 1S CHANGED IN ANY WAY,
BILLING TIME IS % HR BEFORE OLPARTURE TIME AND CONTINUES THROUGH % HR AFTER 2STUDMINE TO
DEPARTURE POINT.
TODAYS DATE: 3\4 | Le
PERSON PLACING ORDER: Mméchells Ber AL do
SCHOOL OR ORGANIZATION:
>
PHONE NUMBR:
NUMBER OF BUSES REQUESTED: 4 lye?
TRIP DATE: ne 3 DUG ap pickue TIME: Kiam £
PICKUP LOCATION: Baad Cacleny
DESTINATION: ‘y ‘ih abe on wa
TIME LEAVING DESTINATION:
TIME BUS WILL ARRIVE BACK AT PICK un mn FD? pn,
DROP-OFF / PICK-UP: iy). Cpe ones OR BUS TO 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 ao OFFS &
PICK UPS BASED ON THE LOCATIONS AND TIMES, #43/.0 0 yt
BASED ON THE INFORMATION ABOVE, THE Cost, PER BUS, FOR THIS TRIP 25310
PURCHASE ORDER #: OR C.0.0,
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
IF YOU HAVE ANY QUESTIONS, PLEASE CALL GREG CORDOVA @ 860-537-2622.
iL :
sowarund Ot as AAD DATE: 3)4)22- _
CONFIRMATION SIGNATURE (M &J BUS INC)
SIGNATURE; DATE:
er