Jefferson Patterson Park and Museum Field Trip Application Form

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Scheduling Procedures:
1. Please fill out this application form.
2. If you plan on bringing multiple classes, use one form per grade. List all teachers on this form and their class sizes.
3. Fee: $5.00 per student. Maximum of 50 students each day. Minimum of 10 students or $50/visit. An invoice will be sent with the confirmation.
4. Confirmations will be emailed to the email address provided by the contact teacher.
5. Once confirmations are received, a $15 non-refundable reservation fee will be due within two-weeks.
5. Please contact Julie Hall with any questions: 410-586-8504 or julie.hall@maryland.gov

Contact Information

Contact Teacher's Name: *

Teacher's email: *

School phone: *

Teacher's cell phone (used for day-of contact): *

Best time to reach you: *

How would you like to be contacted? *

school phone

cell phone

Name of School/Group:

School's Full Address: *

Grade: *

Number of students attending: *

Program Dates

Dates are limited for 2017-2018 school year.
Programs are only held Tuesdays-Fridays. Please list two dates or a range of dates that would work best for your group.

First choice of date: *

Second choice of date: *

Time of Trips

Our programs are scheduled 10:00am - 1:00pm, Tuesday-Friday. Please indicate if the time window does not work for your group to arrange other time.

Typical Lunch Time:

Any other scheduling notes we should know:

Program Selection

Please check the boxes below for the program you would like to schedule. Program descriptions can be found on our website http://www.jefpat.org/education.html

Program: *

Curriculum Support

Describe how this field trip fits into your curriculum and supports your content in the classroom.

Curriculum Unit or Subject:

1. Field Trip Expectations: Describe what you expect from the field trip. List topics/themes you would like to see covered.

2. OTHER INFORMATION that may help us develop a program that best suits your class' needs.

3. Please describe any special needs or accommodations that your students may need.

4.Have you participated in activities at Jefferson Patterson Park and Museum before? If yes, please list which activities:

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