Lead Teacher/Contact Person's Name
* Lead Teacher/Contact Person's Name
Organization Postal Mailing Address
* Organization Postal Mailing Address
Names of All Teachers Attending Field Trip
Lead Teacher or Contact Person Daytime Phone Number
* Lead Teacher or Contact Person Daytime Phone Number
Email of Lead Teacher or Contact Person (must be a valid email address; a non valid email will result in your form being returned without being processed):
Emails of all additional teachers attending the field trip (must be a valid email address; a non valid email will result in your form being returned without being processed):
Email of School Office Manager (must be a valid email address; a non valid email will result in your form being returned without being processed):
Email of Principal (must be a valid email address; a non valid email will result in your form being returned without being processed):
Students (up to 96 students per visit; this is the number that will be on the invoice) - $5 each
Teachers (this is the number that will be on the invoice) - Free
School Approved Chaperones -$7 each
Include chaperones on the invoice?
Yes, please include chaperones on the invoice.
No, do not include chaperones on the invoice. I understand that Field Trips with 10 (ten) or more school approved chaperones must pay for chaperones under ONE payment in advance or under ONE payment upon arrival.
Please list your desired field trip date in order of preference (Tuesday - Friday ONLY).
* Please list your desired field trip date in order of preference (Tuesday - Friday ONLY).
*Please note the following date restrictions: August 12th - September 3rd, May 25th - May 29th, Jun 1st - 5th you can book up to 96 students w/lab or up to 64 students w/out lab during these dates.
Lab Options | Choose Only One Lab or "No Lab"
Discovery Lab (optional, Gr. K-12) - approx. 30 minutes + additional $2 per student | 96 Students Max
Bison Lab (optional, Gr. 9-12) - approx. 1 hour, + additional $5 per student | 40 Students Max
Owl Pellet Lab (optional, Gr. 2-12, see allergy warning in Field Trip Guidelines) - approx. 40 minutes, + additional $4 per student | 96 Students Max
Are you planning on scheduling multiple field trip visits?
Yes, we plan on visiting on 2 (two) or more days
Yes, we are planning an AM (9:30 am) and PM (1:00 pm) field trip on the same day
No, we would like to visit on 1 (one) day ONLY
If you are scheduling multiple field trip visits (more than one day or a 9:30 am and 1:00 pm visit on the same day), please list the requested dates and number of students, teachers and chaperones you are expecting to visit each day:
Please choose ONE time slot for your field trip. All time slots allow 15 minutes for check-in and A.M. (9:30 am) time slots allow for a 30-minute lunch break from 11:45 am – 12:15 pm.
9:30 AM - 12:15 PM
1:00 PM - 3:15 PM
We are requesting both a 9:30 AM and 1:00 PM visit for the same day.
Will your students visit the Museum Store?
Any special notes for your field trip?
By submitting this field trip request, I, as the lead teacher/contact person for my organization, have read and agree to the 2019-2020 Self Guided Field Trip Guidelines for Teachers, policies and notes prior to submitting this request. I understand that Western Science Center Field Trips are self–guided and it is my responsibility to plan and distribute this information to all teachers and chaperones attending the Field Trip(s). By submitting this request form, I consent to and authorize, without further compensation, the use and reproduction of any and all photographs taken of the Field Trip(s) and of anyone associated with the Field Trip(s). All digital copies remain the property of the Western Science Center. I understand that payment in full is required a minimum of two weeks prior to the Field Trip date(s) and that WSC does not provide refunds or accept purchase orders as forms of payment. Memberships and/or other admission passes/coupons cannot be used for field trips. I understand that failure to pay in full by the due date stated on the invoice will result in the field trip(s) being cancelled and that I will receive a cancellation notice via email. I understand that if the field trip(s) are not paid for in full by the due date that my field trip date(s) will be reassigned to another school on the field trip waitlist. I understand that the Western Science Center does not accept a purchase order as a form of payment and that a purchase order cannot be used to “hold” my field trip reservation. I understand that field trip(s) will be charged a $25.00 fee for each returned check. I understand that arriving later than our scheduled time may result in a shortened program and we may not be able to participate in all activities, including labs (if scheduled). I understand that we may not receive field trip coordination in the event of a late arrival. I understand that no refunds or discounts will be given in the event of a late arrival. I understand that morning field trip check in begins promptly at 9:30 am and afternoon field trip check in begins promptly at 1:00 pm. I understand that the field trip is considered late if we arrive 30-minutes or later than our scheduled check in time as confirmed by the field trip confirmation email. I understand that the Western Science Center schedules staff, volunteers and other field trips based on our reservation time and therefore late arrivals can affect the field trip services we receive. I understand that if we opt to show up after failure to pay for a field trip in full by the due date stated on the invoice it will result in the field trip participants being charged the group rate ($5.00 per person with a minimum of 20 guests, ages 5 and up), with no lab or field trip coordination available and another group may be onsite during our visit. I hereby release the Museum authorities, staff, and volunteers from responsibility for accident or injury which may occur due to the negligence or disobedience of field trip participants. In the event of a medical emergency, museum officials have permission to seek medical assistance at the expense of the field trip participants involved. I understand that if field trip participants commit an offense that would normally cause removal from the Museum/Lab while participating in this activity, the field trip will be immediately removed from the Museum/Lab, and will not be permitted to return. No refunds of field trip fees will be given in the event of removal from the Museum/Lab. By signing this form, I understand that the Western Science Center reserves the right to cancel or reschedule Field Trip(s) at any time, for any reason.
I understand that by submitting the Western Science Center Field Trip Request Form online, I agree to the terms and conditions stated in this contract.