Field Trip Request

School

School Name *

Street Address *

City *

State *

ZIP *

County *

Teacher / Primary Contact

Name *

Email *

Phone (School/Daytime)

Phone (Cell) *

Visit Details

Visit

Program(s) interested in: *

Number of Participants *

Grade Levels of Participants *

Dates

Preferred Date of Visit *

Alternate Dates *

Accessibility

Please note that plant tours are NOT ADA-accessible.

Please check any that apply to your group:

One or more participants are deaf or hearing impaired.
One or more participants are blind or have low vision.
One or more participants have a physical disability and/or use a wheelchair, walker, etc.
One or more participants have a developmental or learning disability.

Please describe any accommodations your group will require, and provide any other notes/requests here:

How did you hear about us?

How are (or will you be) connecting this field trip to something your students are learning in the classroom?