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1. Name of School: (Required.)

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2. School Address: (Required.)

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3. Are you a Title I School? (Required.)

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4. Please provide contact information below: (Required.)

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5. Please select school type: (Required.)

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6. Please select the students' grade level: (Required.)

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7. Please provide three potential dates and times for the outing: (Required.)

Date
Time
Date
Time
Date
Time

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8. How many students will be visiting? (Required.)

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9. How many chaperones will accompany the group?
*We require at least one chaperone per 5 Elementary/Middle students and one chaperone per 15 High School students (Required.)

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10. Please select the desired museum activity: (Required.)

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11. Will you need bus transportation? (Please note: Bus transportation is available exclusively for eligible Title 1 schools.) (Required.)

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12. Preferred Tour Language

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13. Accessibility Accommodations "Does anyone in your group (students or chaperones) require specific accessibility accommodations? We are happy to provide support for mobility needs, sensory-friendly experiences (Autism-oriented), or other disabilities."

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14. Lunch Plans "Are you planning to have lunch during your visit?"

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15. Referral Information "How did you hear about the Wynwood Walls field trip program?

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16. How would you describe the group's interest in art?

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17. Anything else you would like us to know?

T