Childrens Museum
Touch Explore Play Learn
Field Trip Request
Teacher's Name
*
School Name
*
School Address
City
State, Zip
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
,
County
*
Phone Number
*
Best Time to Call
Fax Number
Email Address
*
Add-On Options
Gem Mining
Fossil Mining
Soliquid
Tiny Seeds
Tales for Tots
Requested Date of Field Trip
*
Alternate Date of Field Trip
Preferred Arrival Time
9:30
10:00
10:30
11:00
1:00
1:30
Estimated Number of Students
*
Estimated Number of Staff
*
Estimated Number of Chaperones
*
Would you like a STUFFEE program?
No, thank you
My Body
Plants in my Lunchbox
Organs are Important
Would you like information about our lunch package options?
No, thank you
Yes
Comments
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Childrens Museum
