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Group Visit Request
Request Form
Group Visit Request
Group Name
*
"2017-04-17","2017-04-10","2017-04-29"
First Choice Day/Date
*
Year
Year
2025
2026
2027
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
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31
Second Choice Day/Date
Year
Year
2025
2026
2027
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Arrival Time
*
Arrival Time Option
*
AM
PM
Departure Time
*
Departure Time Option
*
AM
PM
First and Last Name of Contact Person
*
Email Address of Contact Person
*
Phone Number of Contact Person (work)
*
First and Last Name of Secondary Contact Person
*
Email Address of Secondary Contact Person
*
Phone Number of Secondary Contact Person
*
Approximate # of Students
*
Approximate # of Teachers
*
Approximate #of Chaperones
*
Address
*
Grade / Age
*
Lunchroom Requested - $25/25 minutes
*
No
Yes
Workshop(s) and Experience(s) Requested
*
No
Yes
All Ages
Slime $2
Light $2
Circuit Builders $2
Static Electricity $2
Biospheres $3
Force & Motion $3
Engineering Design Challenge $3
Grades 2 & Up
Renewable Energy Workshop $3
Gift store shopping allowed?
*
No
Yes
Anticipated Mode of Travel
*
Carpool
Bus
Estimated Number of Buses
*
Any accessibility accommodations needed?
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