This text was produced by optical character
recognition (OCR) of a scanned document and may contain errors. The linked
document above is the authoritative version.
Machine-extracted text of a publicly
posted document, provided for reference and search. The original document at
the link above is authoritative.
Colchester Public Schools
Application for Approval of Field Trip
COLCHESTER
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. If applicable, the Board of Education reviews and makes the final decision.
Today’s Date: 11/21/22
Field Trip Information
ite
Applicant Name: Kevin Burke Method of Transportation: Bus (2)
School: BA [=] Bus Service Number(s) (if applicable): GQ 537 2622
Grade(s) and Group(s):9_4 2 Number of Students: 25-30
Date(s) of Trip: 12/18/22 Number of Day(s) of Trip: 4
Event: Developmental Track Meet
Phone Number:
Destination: ete Q
ed st gh tad) Abssling foi Heh a1 ab
Address f ! State: R |
(for each destination): 4/ Aris beist ap. es O 290 3
Time of Departure From School: gq 36 nym Special Clothing and/or Equipment Required:
Time of Arrival Back at School: Track Uniform
1. Name: Steve Browning Cell Phone: |
2. Name: Jeff Brunoli 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)
Administrator Signatures
Applicant Signature
agemmen de
7 Begve | Recommended Not Recommended
Administrator’s Signature
Superintendent’s Sigyature 7tRecommended | Not Recommended
Board of Education (i appiicabie)
Board of Education Meeting Date: Recommended Not Recommended
Bus Information oe
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
Field Trip Location(s): Povidewee. (areet + Tacha Atadklmy
Reference Check: Visited site on: or Spoke with:
Name: Kevin Burke Grade/Group: 9-12
(Teacher(s) completing this form)
instructional Focus of Trip
e This field trip is directly related to curriculum Yes WI} No
e Curriculum Unit(s):
e 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
12/18/22 Developmental Indoor Track Meet
Approvals oS ee ie 11/21/22 V | Approved Denied
Department Chait (High School Only) Date
Ly Bega (fl fap | Approved Denied
Principal 7 Date
{! / 5 |
/& nN ! tt approved Denied
Biréctor of Teaching and Learning Date
\Indated 5 77 71
Field Trip Cost Form
Date(s) of Trip: 12/18/22
Event: Developmental Track Meet
M&J Bus(es) ONLY
Number of Students: Estimated Hours for trip:
(Add 1 hour pre/post trip)
25-30
° Number of Buses: 2
Per Student Calculations:
M&J Bus(es) ONLY Coach Bus(es) ONLY
Admission per student: 0
Miscellaneous Fees per student: 0
Total admission and miscellaneous fees: 0
Cost of Bus + 5eo0
Total Field Trip *Cost per Student:
Additional Costs:
Number of Substitute Teachers 0
Rate per Day
. Special Education costs 0
Cost Associated if Nursing Required 0
Total *Cost to District:
Total *Cost of Trip:
Alternate funding for trip provided by: none
¢ *Insert these costs on the accompanying Field Trip Application :
Form updated 5.27.21 :