Field Trip Request Form School Name * 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 Contact Email * Number of Students * Groups with fewer students than the group minimum of 15 will be charged for the minimum. Grade Level * Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 K-6 Number of Classrooms * Museum Visit * I am interested in a 60 min Museum Visit ($7.00/student) 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 Pre K + Kindergarten Preschoolers will read a story, explore with materials and tools, and create a project. 60 minute workshop/$9 per student Kindergarten - Grade 2 30 minute workshops: $8.50/student 60 minute workshops: $9/student 90 minute workshops: $11.50/student Grades 3-6 30 minute workshops: $8.50/student 60 minute workshops: $9/student 90 minute workshops: $11.50/student School-Age Care The following workshops work well for mixed-age groups K-5. 30-minute workshops/$8.50 per student 60-minute workshops/$9 per student 90-minute workshops/$11.50 per student 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 Questions or Comments Thank you!
