Full Day Field Trip Reservation Request Form
Contact First Name: *
Your answer
Contact Last Name: *
Your answer
School Name: *
Your answer
District Name: *
Your answer
School Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
Phone Number: *
(School phone number, with extension, OR the best number to reach you)
Your answer
E-mail Address: *
Your answer
Which Full Day Field Trip Experience would you prefer? *
Date of Trip: *
(First Choice)
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Date of Trip: *
(Second Choice)
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Date of Trip: *
(Third Choice)
MM
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DD
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YYYY
What time do you want to start your Field Trip? *
(What time can you arrive to the historic Philadelphia area?)
Required
Estimated Number of Students: *
Your answer
Estimated Number of Adults: *
(We welcome one free adult for every six students. Additional adults are charged at the student rate.)
Your answer
Estimated Number of Nurses, 1:1 Aides, Support Staff for Students with Disabilities: *
(In addition to the estimated number of adults - these adults are all free and not included in the 1 free adult per 6 students ratio)
Your answer
Grade Level: *
(Select all the apply - The Full Day Field Trip Experience is not recommended for students outside of the grade range below)
Required
On-Site Contact Name: *
(This should be an adult that will be with the group on the day of your visit)
Your answer
On-Site Contact Cell Phone: *
(This should be the cell phone number that can be used to reach the on-site contact on the day of your visit)
Your answer
Afternoon Add-On: *
(Some afternoon add-on options may be unavailable based on hours, site availability, and your group's logistical needs)
What time do you need to depart the historic Philadelphia area? *
Time
:
How did you hear about Historic Philadelphia, Inc. and/or our Full Day Field Trip Experience? *
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