Field Trip Request Form

If you would like to request a field trip to the Riparian Preserve for your class, please complete the following:

*Indicates a REQUIRED field

Please complete the following:
*Field Trip Coordinator's Name:

*Coordinator's E-mail:

*Coordinator's Phone Number:

*School/Group Name:

School/Group Phone Number/Extension:

District/City:

PROGRAMS AND DATES: You may request up to three dates on this form. If you have more than three dates, please submit another form.

There is no more availability for the 2007/08 field trip season, but we hope to see everyone in 2008/09!

FIRST DATE REQUESTED
*1st Date Requested:    MUST be in this format: mm/dd/yyyy

*Approx # Of Students Visiting:    (Enter a number only!)

Grade Level:

Topic(s) requested for this date:

SECOND DATE REQUESTED
2nd Date Requested:    MUST be in this format: mm/dd/yyyy

Approx # Of Students Visiting:    (Enter a number only!)

Grade Level:

Topic(s) requested for this date:

THIRD DATE REQUESTED
3rd Date Requested:    MUST be in this format: mm/dd/yyyy

Approx # Of Students Visiting:    (Enter a number only!)

Grade Level:

Topic(s) requested for this date:

Payment Method: Purchase Order   Cash or Check

Please select the number of programs you want:
2 Programs ($3 per student)   3 programs ($5 per student)

     Please refer to the Schedule and Fees page to confirm start and end times.
     Any requested variance to the schedule must be noted in comments section.

Additional Comments: