Piedmont Park Conservancy Field Trip Request
Please complete the following form to request a field trip
* Required
Email address
*
Your email
Contact Information
Name (first and last)
*
Your answer
Indicate which best describes you
*
Teacher
Administrator
Parent
Other:
Name of School or Organization
*
Your answer
Title 1 School?
*
Yes
No
Mailing Address (City, State, Zip)
*
Your answer
Primary Phone Number
*
Your answer
Alternate Phone Number
Your answer
Program Information
Number of Students
Your answer
Number of Adults (1 per 10 students required)
*
Your answer
Grade level (s)
*
Your answer
Date Requested (first choice)
*
MM
/
DD
/
YYYY
Date Requested (second choice)
*
MM
/
DD
/
YYYY
Date Requested (third choice)
MM
/
DD
/
YYYY
Time Requested (earliest time available 9:30am)
*
Time
:
AM
PM
Indicate your desired program (choose "other" for custom program, please elaborate)
*
Babies to Big Ones: K-2
Needs, Seeds, and Nature: Grades 1-2
Habitat Hunt: Grades 3-4
It's Lonely at the Top: Grades 6-8
Historical Tour- All Grades
STEM: Buzz on Bees: Primary (Grades K-2) and Intermediate (Grades 3-5)
STEM: Erosion 101: Primary (Grades K-2) and Intermediate (Grades 3-5)
STEM: Pond Water Web: Grades 3-5
STEM: ExCELLent Adventures: Grades 5 and 7
STEM: Population Density and Biomass Study: Grades 6-8
STEM: Fabulous Fibonacci: Middle School to High School
STEM: Putting Green Into Goldberg: High School
Additional Information (if applicable)
Your answer
A copy of your responses will be emailed to the address you provided.
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