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Field Trip Interest Form
Name of organizer
(Required)
First
Last
Organizer Email
(Required)
Organizer cell phone
(Required)
Institution/School
(Required)
Are you a Title I institution/School?
(Required)
Funds may be available to subsidize your visit.
Yes
No
Would you like to be considered for a subsidy to apply toward your school bus cost?
Yes
No
institution/school address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
County
(Required)
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Other
Grade level of students attending field trip
(Required)
Select all that apply
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
Other
Number of children expected to attend field trip
(Required)
For Jazz Jam field trip, we are limited to 35 students.
Does your group include any children with disabilites who may be accompanied by an aide?
One adult can be admitted for free with each child with a disability over the required 5-to-1 child-to-adult ratio.
Yes
No
If so, how many children?
Program desired
(Required)
Pre-K/K: Color-gories
Pre-K/K: Count it Out
Pre-K/K: Electricity Investigators - Renewables!
Pre-K/K: Desert Dwellers
Pre-K/K: SENSE-sational Senses
1st: Noisy Science: Chicken in a Cup
1st: Wonders of Space
1st: Amazing Murals
1st: Up in the Air
1st: Grossology
1st: Eating our Words
1st: Electricity Investigators - Renewables
2nd-3rd: Wonders of Space
2nd-3rd: Amazing Murals
2nd-3rd: Up in the Air
2nd-3rd: Grossology
2nd-3rd: Noisy Science: Instrument
2nd-3rd: Eating our Words
2nd-3rd: Electricity Investigators - Renewables
2nd-3rd: Electricity Investigators - Renewables
4th-5th: Desert Scientists
4th-5th: Messy Science
4th-5th: Metaphors in Bloom
1st-4th: Electricity Investigators - Power Up!
4th-5th: Jazz Jam: Sound in Motion (Thurs or Fri only)
What language would you prefer for your program?
English
Spanish
Bilingual
Date - First Choice
(Required)
Tuesday-Friday field trips ONLY. Please choose which dates and times work best for you. We'll contact you with your visit time.
Desired time
(Required)
9:30 to 11:30 am
10:30 to 12:30 pm
Either time works
Date - Second Choice
(Required)
Tuesday-Friday field trips ONLY.
Desired time
(Required)
9:30 to 11:30 am
10:30 to 12:30 pm
Either time works
Date - Third Choice
(Required)
Tuesday-Friday field trips ONLY.
Desired time
(Required)
9:30 to 11:30 am
10:30 to 12:30 pm
Either time works
