Field Trip Program Request Form

What types of programs are you interested in?*

Beaver Habitat Investigation
Ecosystem Exploration
Bird Banding: Science In Action
Night Ninjas

Possible dates for field trip*

What time would you like to begin your field trip*

9:45 am
10:00 am

Possible dates for bird migration class*

This field trip has a prerequisite class program on bird migration. The class about 1hr and 15min and is offered between March 18 and April 13. Please list multiple possible dates and times for us to come to your school.

Migration class prerequisite*

Please select the option that applies

My students are between grades K to 3 (please reserve the gymnasium or cafeteria)
My students are 4th graders or above, and I only have one class (we come to your classroom)
My students are 4th graders or above, but I have multiple classes (Please reserve an area where all classes can meet simultaneously)

What is your county?*

What is your school district?*

What is your school's name?*

Does your school have Title 1 status?*

(If so, you may be eligible for tuition assistance)

Yes
No

Your name*

(who should we be in contact with)

Contact person's email address*

Contact person's cell phone number*

What grade level are the students?*

How many students will be attending?*

(Maximum 30, and please note we need 1 chaperone for each 5 students)

Please list any special needs or accommodations that we should be aware of