Field Trip Request
Please use this form to request a Bloomsburg Children's Museum Field Trip. Please note that submission of this form does not constitute a reservation. Our field trip coordinator will contact you within 48 hours. Thank you.
Field Trip Organizer's Name: *
Your answer
Phone Number: *
Your answer
Email Address: *
Your answer
Preferred Method of Contact: *
Best time to reach you?
Will you be attending as a Group Leader? *
If not, please list the Group Leader's Name, Phone Number, and Email:
Your answer
School/Daycare Center/Group Name: *
Your answer
Type of Group: *
Required
School/Daycare Center/Group Address: *
Your answer
School/Daycare Center/Group Phone Number: *
Your answer
Student Grade Level/Age if Applicable: *
Required
First Choice Field Trip Date:
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YYYY
Second Choice Field Trip Date:
MM
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YYYY
Third Choice Field Trip Date:
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DD
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YYYY
Desired time slot for field trip? *
Number of children attending the field trip? *
Your answer
Number of adults? *
Your answer
Will your group be arriving in buses? *
If so, how many buses?
Your answer
Is your group interested in visiting the gift shop? *
Thank you for your interest in a field trip at the Bloomsburg Children's Museum!
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