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  TEACHERS & LEARNING

Field Trip Request Form

Print a PDF version of this form to submit via fax or mail.

See Reservation Procedures for submission instructions.

Required fields are starred.

* School Name:

* Contact Name:
* School Address:
* City/State/Zip:
* Telephone:
* Fax:
* Email:
* Grade Level 6th
(Choose all that apply): 7th
8th
  9th
  10th
  11th
  12th
Undergraduate
* Exhibit Emphasis Global Warming Facts & Our Future
(Choose one): Infectious Disease: Evolving Challenges to Human Health
Please list, in order of preference, the date and time your group would like to visit. Field trips are offered any day of the week in both the morning and afternoon. Tuesdays are preferred because the museum is closed to the general public. Please note that the program will last approximately 2 hours. You will be contacted within two (2) business days to confirm available dates.
* Date 1: / / (Month/Day/Year)
  Morning at (hh:mm)
  Afternoon at (hh:mm)
*Date 2: / / (Month/Day/Year)
  Morning at (hh:mm)
  Afternoon at (hh:mm)
Name of contact to arrive with group
(if different from above):
* Number of students (maximum 36):
* Number of chaperones
The museum requires one (1) chaperone for every ten (10) students . Additional chaperones will be charged admission.
   
*How will you be traveling to the museum?
Free bus
School/charter bus
Public bus
Metro/subway
Private Car
How did you learn about the Koshland field trip program?
Website
E-mail
AIMS Conference
VAST Conference
VAIS Conference
Department/School/District visit by Koshland Staff
Other, please specify:

Special Needs/Requests:

Payment Requirement:If the school is from outside the greater DC metropolitan area^, full admission payment is required to finalize your reservation when your group’s tour date is confirmed.

Payment, Refund and Cancellation Policy

^The greater DC metropolitan area is defined as Washington DC, Montgomery County MD, Prince George’s County MD, Charles County MD, Arlington County VA, Fairfax County VA, Prince William County VA, Loudon County VA and all cities and towns within these counties.

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