Field Trips Request Form - Western Spirit: Scottdale's Museum of the West

Name of School *

School District *

School Phone *

Address *

City *

State *

Zip *

Primary Contact *

First

Last

Email *

If we need to reach you by telephone, please identify the preferred number: *

Names of Additional Teachers

Field Trip Date 1st Choice: *

Please Select One Arrival Time for First Choice Date: *

10:00 a.m.
11:30 a.m.
12:30 p.m.

Field Trip Date 2nd Choice: *

Please Select One Arrival Time for Second Choice Date: *

10:00 a.m.
11:30 a.m.
12:30 p.m.

Grade Level: *

Number of Adult Chaperones within ratio: *

Select Area of Study: *

Number of Students | Enter the Cost *

Number of Students @ $7/student = $____

Additional Adults/Chaperones* | Enter the Cost *

@ $12/person = $________

Total Cost *

We accept cash, business checks, credit cards, and purchase orders. Districts are encouraged to pay via purchase order to receive an invoice. No refunds will be given for reduced attendance the day of visit on pre-written checks. *There is no charge for bus drivers or chaperones within the designated ratio.

Method of Transportation: # of Bus(ses)

Selected Value: 0

Method of Transportation: # of Van(s):

Selected Value: 0

Method of Transportation: # of Personal Vehicle(s):

Selected Value: 0

Are there any special needs we should be aware of in advance of your visit? *

How did you hear about us?