Jefferson Patterson Park and Museum Field Trip Application Form
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:
Your answer
Teacher's email:
Your answer
School phone:
Your answer
Teacher's cell phone (used for day-of contact):
Your answer
Best time to reach you:
Your answer
How would you like to be contacted?
Name of School/Group:
Your answer
School's Full Address:
Your answer
Grade:
Your answer
Number of students attending:
Your answer
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:
Your answer
Second choice of date:
Your answer
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:
Your answer
Any other scheduling notes we should know:
Your answer
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:
Your answer
1. Field Trip Expectations: Describe what you expect from the field trip. List topics/themes you would like to see covered.
Your answer
2. OTHER INFORMATION that may help us develop a program that best suits your class' needs.
Your answer
3. Please describe any special needs or accommodations that your students may need.
Your answer
4.Have you participated in activities at Jefferson Patterson Park and Museum before? If yes, please list which activities:
Your answer
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