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Colchester Public Schools tes
Application for Approval of Field Trip “/ / afc Ge
: Overview: This form must be completed by all staff to request approval of a field trip. Dols
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: Jan 2, 2024
| Field Trip Information Ne
Applicant Name: Waal u “Frat ONCK Method of Transportation: B vs
School: Choose aapaol B acon Bus Service Number(s) (if applicable):
Grade(s) and Group(s): S) 4. LRopottlé Number of Students: /Z (4 Thurs day )
Date(s) of Trip: Mareh( lie 4, a (2 Number of Day(s) of Trip: 2
E t:
ven fies T Robotics Competthon — Westem New England ty
Destination: Phone Number:
Western New England Unv
Address Alumni Heatth fulrling Center | State:
(for each destination): Pea MA MA
Time of Departure From School: Bee che tule Special Clothing and/or Equipment Required:
Time of Arrival Back at School: Club Uniform dL Robot i E. Up meant
Student Cost Information :
*Cost to Student: $ Suggested Student Pocket Money: $ 5S
and cell phone number for each)
Cell Phone:
Jonin Spaulding Cell Phone: —
List all adult eee Ratio of adult chap#rones 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)
See Mthached List
| Administrator UIE
Applicant Signature Lu : ae e
a Gs pLy
Administrator’s Signature Arg Bege- 5 ae ro Not Recommended
Recommended i Not Recommended
| Board of Education (if applicable)
Board of Education Meeting Date:
OULU)
Bus Reservation Date:
*If a trin tna frreian canntry nlaaca ramnlota and attachod tha CIDKAA in:
Field Trip Cost Form
Date(s) of Trip:
March ie, IT +19
Event: FRET Robohics Compenhon— Western New England 0
M&J Bus(es) ONLY
AT BACON AT WNE
Number of Students: Estimated Hours for trip: “Thursday, 4:09, pice uP 4:00, Bekdineth
(Add 1 hour pre/post trip) FRIDAY, Gils PICKUP b:00 Pick UP
a Thursda SATURDAY lous PI OP @!00 Pick LP
J Friday ¥ Samurday Number of Buses: /
Per Student Calculations:
M&J Bus(es) ONLY Coach Bus(es) ONLY
Admission per student:
Miscellaneous Fees per student:
Total admission and miscellaneous fees:
Cost of Bus
Total Field Trip *Cost per Student: O
Additional Costs:
Number of Substitute Teachers O
Rate per Day
Special Education costs
Cost Associated if Nursing Required O
Total *Cost to District: O
Total *Cost of Trip:
Alternate funding for trip provided by: ;
Corporate sponsors of the tam,
*Insert these costs on the accompanying Field Trip Application
Form updated 5.27.21
Field Trip Instructional Plan
Colchester Public Schools
Field Trip Location(s): ELST Robots Compe-hhon -Western New England U
Reference Check: Visited site on:__NA or Spoke with:
Name: Cindy ‘Hausner Grade/Group: 9-12 /K Yor ic
(Teacher(s) cafnpleting this form)
Instructional Focus of Tri
° This field trip is directly related to curriculum [a Yes Rl n0
e Curriculum Unit(s):
© 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
Approvals: eo Approved te Denied
Department Chair (High School Only) Date
Abn, Be jue fez “ Approved Denied
Principal Y go olf : oe =
er get sess lie teued lbenied
Director of Teaching and Learning Date.
Bacon Academy Robotics Team 1699
FIRST Rabotics Competition Event 1
Thursday, March 16- March 18 Western New England University District Event
March 16-PitSetUp School Van Use, tenor) Appre val
M and J bus will pick up Roadie Group of 4 students and 2 mentors td travel to Western
New England University to set up the pit in preparation for competition. 2 Mentors will
drive separately with trailer. Leave Bacon at 4:00 pm and travel to WNE competition site
for pit set up fram 5-9:00 pm. Group will return to Bacon Academy for parent pick-up at
10 pm.
March 17- Team Travel to WNE- SCHOOL DAY
M and J bus will pick students and mentors up and leave Bacon Academy at 6:15 am
for WNE competition site. Site opens at 7:30 am and matches end at 6 pm. Bus Pick-up
will be 6:00 pm. Bus will transport all back to Colchester for a 9:00 pm pick up by
parents. Lunch will be provided by the team on site and the bus will stop for dinner on
the way home.
March 18- Team Travel to WNE for Day 2 of Competition
M and J bus will pick students and mentors up and leave Bacon Academy at 6:15 am
for WNE competition site. Site opens at 7:30 am and matches/awards end at 6 pm. Bus
Pick-up will be 6:00 pm. Bus will transport all back to Colchester for a 9:00 pm pick up
by parents. Lunch will be provided by the team on site and the bus will stop for dinner
on the way home.
Supervision Information:
John L Spaulding 860-234-7058
Alan C Mocksfield 860-949-3292
Jason Belding 860-391-1581
Seth Crampton 860-681-6075
Bradley Graham 860-373-6110
Mark Noniewicz 860-917-8010
M &J BUS INC.
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. 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 TIMES OR
DESTINATION OF THE TRIP IS CHANGED IN ANY WAY.
BILLING TIME IS % HR BEFORE DEPARTURE TIME AND CONTINUES THROUGH % HR AFTER RETURNING TO
DEPARTURE POINT.
TODAYS DATE: [5] 2a
PERSON PLACING ORDER: Sk iN Qi LIC Wiern oe
SCHOOL OR ORGANIZATION: BA Po bs qc.
PHONE NUMBR: g | 5 b1= wl if
NUMBER OF BUSES REQUESTED: — - [AS fusl dees
trip pate: MAKCHt 7 trip pickup time: lo ISAM
PICKUP LOCATION: —3ACON) ACADEMN
pestination: Westevin New Enqlaun A Univ
21S Wilbraham Ra, Sprinameld MA
TIME LEAVING DESTINATION: La1OO par
: SE : 1 e
TIME BUS WILL ARRIVE BACK AT PICK UP: 9:00 ppv Stopp WW A for A Inner
DROP-OFF / RICKAUP: i OR, (BUSTO 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 DROP-OFFS &
PICK UPS BASED ON THE LOCATIONS AND TIMES.
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS TRIP IS:
PURCHASE ORDER fe cx OR C.O.D.
M & J BUS INC. AND ITS EMPLOYEES ARE NOT RESPONSIBLE FOR ANY ITEMS LOST, STOLEN, OR LEFT ON
BUS.
TO RESERVE THE/6US}es FOR THIS TRIP, PLEASE SIGN, DATE, AND FAX BACK TO US AT 860-537-2625
IF YOU HAVE ANY ¢ ei PLEASE CALL.GREG CORDOVA @ 860-537- oer
Y
senotune NN d fo. a
CONFIRMATION SIGNATURE (M & J BUS INC)
SIGNATURE: DATE:
M &J BUS INC.
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 TIMES OR
DESTINATION OF THE TRIP IS CHANGED IN ANY WAY.
BILLING TIME IS % HR BEFORE DEPARTURE TIME AND CONTINUES THROUGH % HR AFTER RETURNING TO
DEPARTURE POINT.
TODAYS DATE: | Je 2 : ee |
PERSON PLACING ORDER: Sk SO Ee t erndre
SCHOOL OR ORGANIZATION: BA Rog BoTIe
PHONE NUMBR: ( & fb oo: ; AVE
NUMBER OF BUSES REQUESTED: —| fees. SS te Vet SS
trip pate: Mareh 1% spe nal Macs
PICKUP LOCATION: LP ACOM Academy
DEsTINATION: Western New Fraland UW, I2is Wilbraham Rd
Sprinanead MAA
TIME LEAVING DESTINATION? lo. OOom
Mm ay ‘ y
TIME BUS WILL ARRIVE BACK AT PICK UP: 9:00pm Sippping for dinner
DROP-OFF / PICK-UP: __V@=_OR_ BUS TOSTAY:
(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 DROP-OFFS &
PICK UPS BASED ON THE LOCATIONS AND TIMES.
BASED ON THE INFORMATION ABOVE, THE COST, PER BUS, FOR THIS TRIP IS:
PURCHASE ORDER #: OR C.O.D.
M &J BUS INC. AND ITS EMPLOYEES ARE NOT RESPONSIBLE FOR ANY ITEMS LOST, STOLEN, OR LEFT ON
BUS.
TO RESERVE THE BUS) S FOR THIS TRIP, PLEASE SIGN, DATE, AND FAX BACK TO US AT 860-537-2625
IF YOU HAVE ae a STIONS, PLEASE Le CORDOVA @ 860-537-2622.
S'S /
SIGNATURE: emma aiesi a ~ DATE:
CONFIRMATION SIGNATURE (M & J BUS INC)
SIGNATURE: DATE: