School Field Trip Reservation Form

School Name:*

Main Contact Name:*

First Last

Main Contact Phone:*

Main Contact Email*

District*

Number of Classes Attending Field Trip:*

1
2
3
4

Grade Level:*

2nd - Habitats & Inhabitants
3rd - Rock Detectives
4th - Cycles, Webs & Chains
4th - Rock Detectives

Total Number of Students Attending (60 max/trip)*

Teacher Contact Information:

Teacher Name:*

Class 1

First Last

Teacher Email*

Class 1

Teacher Cell Phone:*

Class 1

Teacher Name:*

Class 2

First Last

Teacher Email*

Class 2

Teacher Cell Phone:*

Class 2

Teacher Name:*

Class 3

First Last

Teacher Email*

Class 3

Cell Phone:*

Teacher 3

Name:*

Teacher 4

First Last

Email*

Teacher 4

Cell Phone:*

Teacher 4

Select Dates:

Please select the three preferred dates for your field trip that you found on the calendar above:

1st Choice:

2nd Choice:

3rd Choice:

Method of Payment:

PAYMENT OPTIONS: You may pay in advance by check or cash, or we will invoice you. To pay from invoice, please upload a completed purchase order from the learning institution and note the purchase order number in the box below.

Indicate your preferred method of payment?*

Purchase Order
Check from PTA or School
Cash

Purchase Order #

Purchase Order (please upload)

Rates and Scholarships:

Rates are based on Title 1 percentage of school population (students that qualify for free and reduced lunch).

Select your schools percentage

50% or more = $2.50 per student
35-45% = $5.50 per student
N/A = $8.50 per student

BUSES: Please indicate if you require help with transportation costs

NOTE: Your field trip must occur prior to Nov. 10 to qualify for assistance.

Yes
No

We schedule field trips on a first-come first-served basis, so schedule soon!

Scholarship rates are made possible through the generous contributions of donors and members of the Highlands Center for Natural History. Figures for the Federal Free and Reduced Lunch Program are available from your school district Food Service department. We require this information to be included on your reservation form so we can invoice the school for the correct scholarship amount. No schools will be turned away solely based on financial reasons.

Please feel free to contact our Education Coordinator, Jessie Manley-Ewald, at (928) 776-9550, if there are financial restrictions placed on your class and students that may prevent you from attending our program. We will do our best to accommodate your needs.

School Field Trip Reservations

This calendar shows what dates are available for field trips.

Teacher Contact Information:

Select Dates:

Method of Payment:

Rates and Scholarships:

We schedule field trips on a first-come first-served basis, so schedule soon!

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