Field Trip Request Form
Please fill out the following information to request a field trip to Blocks to Bricks Museum and a staff member will contact you to answer any questions or to confirm your trip date. A receipt of the information provided will be sent to the e-mail address provided upon completion.
Prices: Grades 1-5- $8, Grades 6-12- $10, chaperones outside a 1:5 ratio- $10
Email address *
Name of School/Organization *
School/Organization Address *
Please include full mailing address for the school (including city/state/zip)
School/Organization E-mail
If available, please provide a general e-mail address for the school
Contact Name *
Contact Phone *
Number students *
Please provide as close to accurate count of students planning to attend as possible.
Number Teachers/Chaperones *
Please include the number of teachers/aides/parents that will be in attendance as well. Some of these will be granted free admission with students.
Date/Time of Visit Request 1st Choice *
The earliest field trip time slot is 10:15am, the latest is 6:30pm Monday-Friday.
MM
/
DD
/
YYYY
Time
:
Date/Time of Visit Request 2nd Choice
The earliest field trip time slot is 10:15am, the latest is 6:30pm Monday-Friday.
MM
/
DD
/
YYYY
Time
:
Date/Time of Visit Request 3rd Choice
The earliest field trip time slot is 10:15am, the latest is 6:30pm Monday-Friday.
MM
/
DD
/
YYYY
Time
:
Would you be interested in adding the Vault Experience? *
This is an add-on experience and subject to availability. This is a guided tour through the museum founder's office and work-space and provides groups with the opportunity to ask questions.
Student Grade Level(s)
To help staff plan for the field trip, please indicate the grade level(s) that will be attending the scheduled trip.
Additional Requests/Comments *
Please let staff know the goals of the field trip and how it can be coordinated to best achieve those goals. Any relevant specific curriculum or topic focus for the field trip is greatly appreciated.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Blocks to Bricks, Inc.. Report Abuse