Field Trip Booking Request Form

In Person Field Trip Request

Name*

First

Last

School or Organization*

Email*

Phone*

Area Code

-

Phone Number

Number of Students Attending (Min 10-Max 24)*

Number of Chaperones (at least 1:10 chaperone to student ratio required)

Grade Levels *

3-5

6-8

9-12

Workshop Topic(s)/Services *

E-Textiles: Interactive Textile Lab

Arduino: Plug, Code, Create: Smart Hardware Studio

Monthly Maker Series 1 hour workshop

Professional Development: 3D Printing 101

Professional Development: Maker EDU 101

Please provide two preferred dates for field trip visit.

Are you interested in purchasing a lunch add-on from the museum cafe? ($10 per visitor)

Yes

No

Please indicate special accommodations, or allergies, if any.

Additional Comments