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.
Email address *
Name of School/Organization *
Your answer
School/Organization Address *
Please include full mailing address for the school (including city/state/zip)
Your answer
School/Organization E-mail
If available, please provide a general e-mail address for the school
Your answer
Contact Name *
Your answer
Contact Phone *
Your answer
Number students *
Please provide as close to accurate count of students planning to attend as possible.
Your answer
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.
Your answer
Date/Time of Visit Request 1st Choice *
The earliest field trip time slot is 10:15am, the latest is 6:30pm Monday-Friday.
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Date/Time of Visit Request 2nd Choice
The earliest field trip time slot is 10:15am, the latest is 6:30pm Monday-Friday.
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Time
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Date/Time of Visit Request 3rd Choice
The earliest field trip time slot is 10:15am, the latest is 6:30pm Monday-Friday.
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Time
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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.
Your answer
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.
Your answer
A copy of your responses will be emailed to the address you provided.
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