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Field Trip Request
Please use this form to request a Bloomsburg Children's Museum Field Trip. Please note that submission of this form does not constitute a reservation. Our field trip coordinator will contact you within 48 hours. Thank you.
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* Indicates required question
Field Trip Organizer's Name:
*
Your answer
Phone Number:
*
Your answer
Email Address:
*
Your answer
Preferred Method of Contact:
*
Email
Phone
Other:
Best time to reach you?
Morning
Afternoon
Other:
Clear selection
Will you be attending as a Group Leader?
*
Yes
No
If not, please list the Group Leader's Name, Phone Number, and Email:
Your answer
School/Daycare Center/Group Name:
*
Your answer
Type of Group:
*
School Group
Daycare
Special Needs Group
Community Organization
Youth Group
Other:
Required
School/Daycare Center/Group Address:
*
Your answer
School/Daycare Center/Group Phone Number:
*
Your answer
E
*
Pre-K (3-4 year olds)
Kindergarten (5-6 year olds)
First Grade (6-7 year olds)
Second Grade (7-8 year olds)
Third Grade (8-9 year olds)
Fourth Grade (9-10 year olds)
Fifth Grade (10-11 year olds)
Sixth Grade (11-12 year olds)
Seventh Grade (12-13 year olds)
Eighth Grade (13-14 year olds)
High School
Other:
Required
First Choice Field Trip Date:
MM
/
DD
/
YYYY
Second Choice Field Trip Date:
MM
/
DD
/
YYYY
Third Choice Field Trip Date:
MM
/
DD
/
YYYY
Desired time slot for field trip?
*
10:00am - 12:00pm
10:30am - 12:30pm
11:00am - 1:00pm
11:30am - 1:30pm
12:00pm - 2:00pm
12:30pm - 2:30pm
1:00pm - 3:00pm
Number of children attending the field trip?
*
Your answer
Number of adults?
*
Your answer
Is your group interested in visiting the gift shop?
*
Yes
No
We are not interested in visiting the gift shop but we would like information on purchasing gift bags for our group.
We are not interested in visiting the gift shop but we would like information on purchasing t-shirts for our group.
Thank you for your interest in a field trip at the Bloomsburg Children's Museum!
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