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Evening of Play
TUESDAY - FRIDAY
Field Trip Interest Form
Name of organizer
*
First
Last
Email
*
Phone
*
Institution
*
Are you a Title I institution?
*
Yes
No
Funds may be available to subsidize your visit.
Would you like to be considered for a subsidy to apply toward your school bus cost?
Yes
No
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Grade level
*
Select all that apply
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
Number of children
*
Does your group include any children with disabilites who may be accompanied by an aide?
Yes
No
One adult can be admitted for free with each child with a disability over the required 5-to-1 child-to- adult ratio.
If so, how many children?
Program desired
*
Pre-K/K: A Census of Our Senses
Pre-K/K: Color-gories
Pre-K/K: Count it Out
Pre-K/K: Electricity Investigators
Pre-K/K: Desert Dwellers
1st-3rd: Wonders of Space
1st-3rd: Dino Discovery
1st-3rd: Messy Science
1st-3rd: Amazing Murals
1st-3rd: Up in the Air
1st-3rd: Grossology
1st-4th: Electricity Investigators—Power Up!
4th-5th: Desert Scientists
What language would you prefer for your program?
English
Spanish
Bilingual
Date - First Choice
*
Tuesday-Friday field trips ONLY. Please choose which dates and times work best for you. We'll contact you with your visit time.
MM slash DD slash YYYY
Available time:
*
10 to 11:30 am
Noon to 1:30 pm
Date - Second Choice
*
Tuesday-Friday field trips ONLY.
MM slash DD slash YYYY
Available time:
*
10 to 11:30 am
Noon to 1:30 p.m.
Date - Third Choice
*
Tuesday-Friday field trips ONLY.
MM slash DD slash YYYY
Available time:
*
10 to 11:30 am
Noon to 1:30 p.m.