Field Trip Request - CCPLS - All Four Branches
Please fill out the below form if you are requesting a field trip for a group of children, 18 years old or younger.
When I Say Field Trip I Mean ...
I would love for someone to come visit us at our location!
I would love to have a group of children visit one of the libraries!
Select Your Students Age Ranges:
2 to 4 years old
5 to 11 years old
12 to 15 years old
16 to 18 years old
How Many Children Are You Planning On Attending?
How Many Guardians Are You Planning To Supervise At All Times?
Library Branch of Interest And/Or Closest Branch:
CCPL in Rustburg
Staunton River Memorial Library in Altavista
Patrick Henry Memorial Library in Broookneal
Are You Part Of A School, Daycare, or Similar Organization?
If You Answered Yes, Please Let Us Know Your Group's Name:
Field Trip Coordinator's Name:
Field Trip Coordinator's Email Address:
Field Trip Coordinator's Phone Number:
Field Trip Coordinator's Cell Phone Number:
Requested Date Of Visit:
Request Field Trip Start Time (check all that could apply):
By filling out this form does not guarantee a field trip for my organization
This form is a request for a field trip based off of the schedules and availability of staff at that time.
If this field trip form gets lost in cyber space, I will follow up with Katie Lane or Valinda Trent.
I must supervise all children and adults that I bring to the library at all times.
If for whatever reason that library cannot accommodate me at this time, I know that they still love me and I will try again.
What Is Your Desired Outcome Of The Field Trip?
Quick Tour - Nothing fancy! - Around 15 minutes
Scavenger Hunt & Quick Storytime - Around 40ish minutes - Typically for third grade and under
Tour With Scavenger Hunt Based Off Of Tour Info - Around 40ish minutes - Typically for third grade and over
Anything else you would like for us to know?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service