THCM Field Trip Request Form

Terre Haute Children's Museum

Field Trip Request Form
School*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Lead Contact Name*
Lead Contact Phone Number*

Area CodePhone Number
Lead Contact E-mail*
Preferred method of contact?*

EmailPhoneEither
Field Trip Information
Field trips are conducted Wednesday through Friday beginning at 9 a.m. and scheduled up to every 30 minutes thereafter. A field trip lasts 2 hours. A discount is provided to field trips of 15 or more students. All times are in Eastern Standard Time (EST).

There may be multiple schools visiting the Museum at the same time. To ensure all classes have a great experience, we keep a close eye on the total number of students and various grade levels visiting at any one time. To give your class the best experience, we ask that you provide us with three choices for the date of your trip.
Field Trip Date Requested (First Choice)*

MonthDayYear
Arrival Time (EST) Requested (First Choice)*
Second Choice Field Trip Date Requested (not first choice date)*

MonthDayYear
Arrival Time (EST) Requested (Second Choice)*
Third Choice Field Trip Date Requested (not any of above dates)*

MonthDayYear
Arrival Time (EST) Requested (Third Choice)*
Number of Students*
Discounts apply for groups with 15 or more students.
Number of Adult chaperones*
Number of School staff*
Grade Level- old

Pre-KK123456Other
Grade Level(s) mark as many as apply,*

PreKK123456Other
How many students in 3rd grade or older? These students are required to take a lab during their visit.
You may choose to have one lab or two labs on different topics.

One lab topic (45 minutes)Two lab topics (1.5 hours)
Field Trip Labs are optional for PreK-2nd grade. They are required for 3rd-6th grade. Which Field Trip Lab would you prefer?
For your second lab, which Field Trip Lab would you prefer?
How will you be arriving?*
Number of Buses*
What type of Vehicle?*
Special Needs? (Please specify)
Are you wanting to eat lunch at the museum? There is a $1 per child fee.*
How would you like to pay?*

Day Of Field TripInvoice
Are you wanting to eat lunch at the museum?
# Student Admission Only $6 each
Enter if not eating lunch at museum
# Student Admission with Carry-In Sack Lunch $7 each
Enter if you are eating lunch at museum
# Adult Admission $3*
Must enter at least 1 for every 5 children
# School Staff $0*
Must enter at least 1
Total Amount Due
Amount automatically calculated
Field Trip Policies
There is a 5:1 Adult to Child ratio required.*

I Agree
Required number of Chaperones
THCM will not accept memberships, admission tickets or discounts for field trips*

I Agree
Payment must be received in a SINGLE check, credit card or cash transaction. All guests NOT INCLUDED in field trip count will be charged $9.*

I Agree
Signature*

Clear
Should be Empty:

Terre Haute Children's Museum

Field Trip Information

Field Trip Policies