Field Trip Reservation Form

Primary Contact (Person responsible for organizing the field trip)

First Name

Last Name

Primary Contact Email

Phone

(###)

###

####

School District, School Site and/ or Organization

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of students attending

Please note group size, including all attending adults, must not exceed 30 without prior approval.

Grades and/ or age range of students

Number of chaperones attending

Group size including students and all attending adults must not exceed 30

Learning targets and goals

Please provide a brief description of the purpose for the field trip

Field Trip Location

Doolittle County Park and Gales Pond

Otto Nature Preserve

Other

Field Trip Date Requested

Contact Educator Kari Wilson to arrange date and time for your field trip.

YYYY

Alternate Date

YYYY

Start time for the 1.5 hour program

Hour

Minute

Second

Payment

A minimum booking of $100 with a $50 deposit is required to schedule a field trip.

I will make an on-line payment of the $50 deposit now and bring the balance due on day of programming

I will make an on-line payment of total program fees of $100 now (group size 20 or fewer. $5 for each additional attendee may be paid on site.)

I will call the office to make payment arrangements