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2025-2026 AtlantiCare LifeCenter Field Trip Request Form

Please complete the form below if you are interested in visiting the AtlantiCare LifeCenter in EHT with your students. This field trip is open to high schools only.

  • 1 field trip per school per school year.
  • Field Trip will be from 9AM-12PM with option to pack lunch and eat onsite.
  • A LifeCenter waiver must be completed by each student/staff to participate in all activities.
  • An AtlantiCare media release form will be shared to complete for any students/staff who wish to be in photos.
1.School Name:(Required.)
2.School Address: (Required.)
3.Name of Person Completing Form:(Required.)
4.Email of Person Completing Form:(Required.)
5.Alternate Contact Name:(Required.)
6.Alternate Contact Email:(Required.)
Please provide an estimate of the demographics of students participating in the activity:
7.Provide an estimated percentage:(Required.)
8.Provide an estimated percentage:(Required.)
9.Age Group:(Required.)
10.Number of students who will participate (48 maximum):
(Required.)
11.Grade Level(s):
12.Requested Date:
(Please be as specific as possible to assist with scheduling and list multiple date options. Requests must be made at least 3 weeks in advance.)(Required.)
Thank you for submitting this request. An AtlantiCare Healthy Schools Team member will contact you within 72 hours to discuss the availability of our team and to schedule this activity.