Field Trip Request Form

Contact Name *

First Name

Last Name

School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Phone Number Type

School

Cell

Grade Level *

Pre-K

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

K-6

Museum Visit *

I am interested in a 60 min Museum Visit ($7.00/student)

I am interested in a 30 min Museum Visit plus a workshop ($5.00/student plus workshop fee)

I am interested in a 60 min Museum Visit plus a workshop ($5.00/student plus workshop fee)

I am interested in a Workshop Only Visit

Date Option 1 *

Please type in your first choice date option (DD/MM/YY).

MM

DD

YYYY

Date Option 2

Please type in your first choice date option (DD/MM/YY).

MM

DD

YYYY

Date Option 3

Please type in your first choice date option (DD/MM/YY).

MM

DD

YYYY

Preferred Start Time *

Please type in the preferred start time for your Museum visit or workshop.

Hour

Minute

Second

AM PM

Photo Release Option *

The Works Museum uses photography to display exhibits, events and workshops for marketing purposes in print publications and on the website. Please indicate whether you give permission for photographs of your group to be used by The Works Museum. If used in any of our print or electronic publications, students will never be identified by name or school.

Yes

No