DOC110624 (1) — Colchester Document Library

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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. \fapplicable, the Board of Education reviews and makes the final decision.

Today’s Date:
Applicant Name: Lynn G codawin Method of Transportation: hn bus
School: Gkeese-Sekeo! WwW SIMS Bus Service Number(s) (if applicable):
Grade(s) and Group(s): 5m Grse$ ‘und [Crores Number of Students: SO

Number of Day(s} of Trip: I

Broaduieg, munsicel ot Tondh j m NYC

set Phone Number:

Yor 80 -€77- 1806
Address [BH Groeduag (M4. Ww Som St) State: NY

(for each destination): . :
Time of Departure From School: 7:60AM Special Clothing and/or Equipment Required:
Time of Arrival Back at School: N / BK

lent: $ We. 5d Suggested Student Pocket Money: $ 205d

: Ly CellPhone: &% 0-33 4- Gat
2 Name: Leith i Cell Phone: S170 - 204-1777
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)

Thare will he 5 +tacher/ Adm. chapertvus on ‘Ws “np.

T}Recommended Not Recommended

Bel Recommended Not Recommended

Nd : | Recommended [ | Not Recommended

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): “Br padus day, NYC
Reference Check: Visited site on:_4/a++ or Spoke with: Jesn D ou an Siler Mill awe
Name: Lunn a orduin Grade/Group: fe Grade Chorusl baud

(Teacher(s) completing this form)

Instructional Focus of Trip

¢ Curriculum Unit(s): | } 2. ond

© Specific Curriculum Standards Addressed by Field Trip (please refer to CT Core and disciplinary standards):
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Pr 4.3-E.Wo oy. 1.€.tb ReT.1.€. 8a
Or 5.1. E Wa Re 8.1. €.56 Re7-3-F. Ge

e Assessment of Student Learning (describe or attach the work students will complete upon their return to
convey the learning):

We ove rehearsre one df Yur preeee fan The Shaw Fhe Lion King,
We will be Cong Cae A Verermns 4 Te pitres ond
weites. alond the. Offehener of watthiry a ive perfrvnones:

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
4|. 3 aving to NYC
\ a Rok :
. The Lim
“60 oach bus
: tan Sto
Ww.
Approvals: Approved Denied
Department Chair (High School Only} Date
foe. g y
CE LPF ‘Approved Denied
Principal Date
Cynol L iO. v pproved Denied
Assigtagtt Superintendent Date

Undated 3.7.2023

wi Field Trip Cost Form
Date(s) of Trip:

Event:
M&J Bus(es) ONLY
Number of Students: Estimated Hours for trip:
Kk (Add 1 hour pre/post trip)
Number of Buses:

Per Student Calculations:
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:

Additional Costs:
Number of Subétitute Teachers

Rate per D
Special Education costs

Cost Associated if Nursing Required

Total *Cost to District:

Total *Cosi of Trip:

Alternate funding for trip provided by:

*Insert these costs on the accompanying Field Trip Application Form updated 5:27.21