Field Trip Request Form

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The field trip booking process begins when a teacher fills out this form to request a trip. Once you have filled out all of the required information and submitted this form, a MOD administrative staff member will call you within five business days to finalize the reservation and discuss payment terms. Field trips are designed for childcare centers, preschool and K-12 schools. Please visit sccmod.org/field-trips to learn more.

Email *

School name *

Grade level *

Contact teacher first name *

Contact teacher last name *

Contact teacher email address *

Number of classes on field trip *

Are you interested in receiving information about our Guided Activities? We currently offer five add-on STEM activities that invite your students to explore a scientific concept in depth with exciting materials (like liquid nitrogen!) *

Yes

Other:

Are you a MOD member? *

Yes

First choice date *

YYYY

Second choice date *

YYYY

Arrival time (field trips are typically 1.5 hours long) *

Time

Arrival type *

Bus

Carpool

Public Transit

Walking

Your phone number for us to call to finalize your booking (include extension if needed) *

Best time to reach primary contact *

Time

School address *

City *

ZIP code *

How did you hear about field trips at the MOD? (choose as many as apply) *

I’ve gone on trips in the past

A colleague recommended them

I received an email

On social media

Brochure mailed to my school

The MOD website

Other

Required

By checking below you are acknowledging and accepting the following terms: Monitoring of students’ behavior is the group’s responsibility. Groups unable to properly monitor their students may be asked to leave. Bringing enough chaperones (one adult for every eight students) is the responsibility of the school staff. Chaperones must be at least 18 years old. It is the group’s responsibility to arrange for all transportation needs.You will receive a preliminary confirmation of your order by email and a phone confirmation within 5 days. Payment in full is required 3 days from the day of field trip. *

I agree

Cell phone number for the day of your field trip (please include area code) *

Send me a copy of my responses.

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