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Field Trip Form
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School Name
Your answer
School Address
Your answer
School City
Your answer
School State
Your answer
School Zip Code
Your answer
District
Your answer
Teacher/Contact Name
Your answer
Email
Your answer
Phone
Your answer
Grade Level
Your answer
Subject You Are Teaching
Choose
ELA
Social Studies/History
Music/Arts
Religion
Other
Are you currently teaching the Holocaust?
Yes
No
Clear selection
I would like to book a
Choose
In Person Field Trip
360 Virtual Field Trip
Live Stream Field Trip
Number of Students
Your answer
Number of Adults (teachers & chaperones)
Your answer
First Choice for Field Trip
MM
/
DD
/
YYYY
Second Choice
MM
/
DD
/
YYYY
Third Choice
MM
/
DD
/
YYYY
Time of Arrival
Time
:
AM
PM
Time of Departure
Time
:
AM
PM
Are you interested in a self-guided or docent led field trip?* (Docent-led field trips are available upon request and based on availability. Additional costs)
Choose
Self-Guided Tour
Docent Led
Are you interested in possibly having a speaker for your group? This is an hour long presentation from a survivor or a relative of a survivor to share their story. A speaker would cost an additional $100.
Choose
Yes
No
Please let us know if you have any special needs or accommodations for your field trip.
Your answer
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