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*
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.