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Colchester Public Schools
SCHOOLS Application for Approva! of Field Trip
Overview : This Form must be completed by all staff to request approval of a Field Trip
Directions
1 . Complete the form with all applicable documentation and submit to your Department Head (BA only) and your Administrator.
The
Form must be submitted at least 2 weeks prior to the Field Trip for ln-State Trips and 10 weeks prior to the Field Trip for Out-of-State Trips.
2. lf approved by your Administrator, the form must be sent to the Assistant Superintendent for approval.
3. lf approved by the Assistant Superintendent, the form will be sent to the Superintendent for approval.
4. lf the Trip is Out-of-State, it will be brought to the Board of Education at their next scheduled Meeting for approval and final decision.
lnstructional Focus
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ls this Trip directly related to curriculum? /Yes) No CurriculumUnit: | ,l a -7
Field Trip Information
Applicant Name €r"oA^rtk Method of Transporta lion : ( ;1g I R,1-S
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School : W J:IrtlS Bus Service Number : il I 14
Grade(s) & Group(s) : Xln 6r. h^rl lC)rn.w Numberof Students 5O
of Tri p w Number of Day(s) of Trip
Event o- 1c
Destination , t)t ) 7 Vr,tt- Phone Number
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DestinationAddress . I tu)3Ll *O"A*t d''ffi" 1t!
0 Clothing / Equipment Required
Time of Departure from School : ].. Ogl A.fl.
Time of Arrival to School , 4; 6l)
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Student Cost lnformation
*CosttoStudent$S Suggested Student Pocket Money $
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Su pervision I nformation
1. Name : lrttn,tt 6oOhrli, CerrPhoneI n)0 .3311-b*lt
2. Name fLlr^ NLxn<s,tt- CellPhone: ?140 - ,303- 1111
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:'l 0
for Grades 6-8 and 1 :15 for Grades 9-12 (1 day trips) or 1 :'l 0 (overnight trips)
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Adm inistrator Signatu res
Applicant qtXri.^ - Date l la lcS
Department Cnair leA d/ Date Denied
Principal/Administrator J ]uut tr'nn il (f oate Q-e-eq @ Denied
Assistant
^rAJ Date Denied
Su Date Denied
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Board of Education Date
q Denied
Page 1 Updated October 2024
Field Trip Instructional Plan
Field Trip Location
Reference Check : Visited Site n OR Spoke with s s
Name of Staff Completing Form :
Grade / Group Attending
lnstructional Focus of Field Trip
Specific Cuniculum Standards Addressed by Field Trip:
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Assessment of Student Learning
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Trip Agenda/Activities
LisUAttach entire break out of times for each d ay. lnclude travel time and all activities
Datefiime Location Activity
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Bus lnformation
Bus Reservation Date N I W Price of Bus(es) $ A//A
Page 2 Updated Oclober 2024