Youth Intake Form

Path to Greatness Sponsored Field Trips Request Form for NAFC Schools

Powered by the Caesars Foundation of Southern Indiana
Contact Name:*

First NameLast Name
Contact E-mail:*
Contact Cell Phone Number:*

Area CodePhone Number
NAFC School:*
School Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
School Phone Number:*

Area CodePhone Number
School Field Trips are available Wednesday-Friday, 10:00 AM - 2:00 PM. Unless otherwise noted, field trips will be scheduled as self-guided visits for 2-hour blocks. Please note the Ali Center is closed on Mondays and Tuesdays.
Requested Visit Date 1:*

MonthDayYear
Requested Visit Date 2:*

MonthDayYear
Requested Arrival Time (EST):*

:HourMinutesAM/PM Option
# Buses: *
Estimated Cost of Buses: This sponsorship provides a transportation reimbursement to schools for the costs of utilizing approved NAFC transportation vendors for pickup and return from one destination between the hours of 9:00 A.M. -2:00 P.M. NO ADDITIONAL STOPS INCLUDED. Schools must submit digital copies of bus receipts in a timely manner to receive this travel reimbursement. *
Number of Students: *
Number of Chaperones*
The Ali Center requires 1 chaperone for every 10 students.
Grade(s):*
Special Needs or Disabilities:
How did you hear about the Ali Center?
I hereby certify that the school listed above is a middle school or high school in the New Albany Floyd County school system. I understand that submitting this form does not guarantee funding. I understand that submitting this form does not constitute a field trip reservation. I understand that my school must provide the Muhammad Ali Center with digital copies of receipts for our field trip bus transportation in a timely manner in order to receive travel reimbursement.*

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Date*

MonthDayYear
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Path to Greatness Sponsored Field Trips Request Form for NAFC Schools

School Field Trips are available Wednesday-Friday, 10:00 AM - 2:00 PM. Unless otherwise noted, field trips will be scheduled as self-guided visits for 2-hour blocks. Please note the Ali Center is closed on Mondays and Tuesdays.