Summer Daycare/Youth Groups Field Trip Request Form

Leader/Teacher Information

Name: Phone:

Email: (required)

Group Information

Organization name:

Address:

City: State: Zip:

Minimum Child Age:

Maximum Child Age:

Number of Children:
(Fees: $6/student for a joint 2-hour Barlow program AND Weis tour, Additional $3/student for each additional program)

Number of Chaperones: (One adult chaperone is admitted free for every 10 students)

Date/Time Request

1st Date Choice: Time:

2nd Date Choice: Time:

3rd Date Choice: Time:

Tour/Program Information

Barlow Program:

You can choose a specific program at the Barlow using the drop-down menu, or let us select an age-appropriate program for you.

(Minimum Fee: $50)

Weis Tours:

Your tour to the Weis Earth Science Museum will be tailored to the age of your group. All tours are educational, exciting and fun!

(Minimum Fee: $50)

Additional Program:

(Minimum Fee: $50)

Extras

Gift Shop? Yes No

Lunch Area? Yes No (Additional Fee: $30)