Holocaust Memorial Center Group Tour Intake Form
1. Group Information
Name of Institution *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
County (Oakland, Macomb, Wayne, etc.) *
Your answer
Zip Code *
Your answer
Type of Organization/School
If your group is coming from a school, is the school Title 1? *
2. Contact Person
Name *
Your answer
Work Phone # *
Your answer
Cell Phone # (required in case we need to reach you the day of the tour) *
Your answer
Email Address *
Your answer
Preferred method of contact (please check one) *
Will the contact person be attending the tour? *
Please provide the name for a second teacher or chaperone *
Your answer
Cell phone number of second teacher or chaperone *
Your answer
3. About Your Group
Areas of study (check all that apply) *
Required
What is the basis of the group's Holocaust education? (check all that apply) *
Required
Please tell us about your group *
Your answer
Please tell us about your group's familiarity with the Holocaust *
Your answer
Please tell us about any relevant background your students have studied or will study before their visit *
Your answer
What specific themes would you like addressed in your visit? *
Your answer
4. Tour Group Size and Grade(s)
Please let us know how many students you will be bringing on the tour. If you are not sure of the size, please estimate based on the largest possible number. Please note—we cannot accommodate more than 120 students at a time.
Please enter the total number of students. *
Your answer
Please enter the total number of adults/chaperones. *
Your answer
Your group is required to have 1 chaperone for every 10 students. If we do not have the required number of chaperones we will have to reschedule. *
Required
Please indicate how many students you will be bringing from all applicable categories below.
Please indicate how many students you will be bringing from all applicable categories below.
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College Students
Adult Group
Please specify any special needs among your students *
Required
Please give details or relevant information for any special needs
Your answer
HMC cannot provide a staff person to chaperone a student with special needs. *
Required
Your group must provide juice, crackers or other snacks, as well as EpiPens and other emergency medications for the students. *
Required
5. Date/Times
Tour Dates: Please indicate your first, second, and third choices
1st *
MM
/
DD
/
YYYY
2nd *
MM
/
DD
/
YYYY
3rd *
MM
/
DD
/
YYYY
Preferred tour start time with speaker *
Please note that if you need to leave before the scheduled departure time you may have to forego the survivor speaker. *
Required
Preferred start time without speaker *
In case we cannot accommodate your preferred dates, please give us your preferred day(s) of week that your group can come. First choice:
Second choice:
Third choice:
6. Payment Information
Do you require an invoice? *
If "yes," to whom do we send it? Please provide address and phone if different from contact information listed above
Your answer
Please indicate how you will be paying for the tour *
Please indicate when you will be paying for the tour *
Thank you for your interest in a group tour at the Holocaust Memorial Center
Please note that this submission IS NOT a confirmation. Once your form has been submitted you can expect to hear back from a staff member within 7 business days to complete the reservation.
Please note that this form is not a confirmation. You will be contacted by the HMC to confirm our tour. *
Required
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