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* 1. School Name

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* 2. School Location (City, Zip Code):

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* 3. Contact Person's Name:

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* 4. Contact Person's Email:

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* 5. Grade(s) of field trip participants:

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* 6. How many students are in your group (approximately)?

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* 7. How much time can you dedicate to this experience (an hour? half a day? full day?)

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* 8. Which subjects are of special interest to your group? (check all that apply)

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* 9. Are you interested in visiting any other destinations on this fields trip? (f.ex. Hartman Rock Garden, Snyder Park, Springfield Museum of Art, Heritage Center, etc)

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* 10. If applicable, please share a little bit about your goals for this field trip experience.

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