Field Trip 25-26 Request Form

1
School/Organization Name* This field is required.
2
Type of School* This field is required.
Please Select
Please Select
Public
Private
Charter
Homeschool Co-op Group
Church Group
Summer Camp
Other
3
Is this a Title 1 School?* This field is required.
YESNO
4
Full Name of Contact Person* This field is required.
First Name
Last Name
5
Phone Number for Contact Person* This field is required.
Please enter a valid phone number.
6
Email for Contact Person* This field is required.
example@example.com
7
Primary Field Trip Request Date and Start Time* This field is required.If you want a different start time other than what is listed, please identify that in the notes. The length of your trip will be determined by the number of students.
8
Secondary Field Trip Request Date and Start Time* This field is required.If you want a different start time other than what is listed, please identify that in the notes. The length of your trip will be determined by the number of students.
9
Grade Level(s) of Field Trip Participants (Select multiple if applicable)* This field is required.
Pre-K and Lower
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
10
If bringing multiple grade levels, please be let us know approximately how many in each grade level are coming.
11
Are you going to be traveling to BrickEd for your trip?* This field is required.Address: 1406 West Innes St, Suite B, Salisbury, NC 28144
Yes we are coming to you!
No we would like for you to come to us (no free play time, add travel fee (differs upon distance)
12
List 2-4 standards that you would like to address within your field trip. If you do not have standards, or want us to decide for you, please put that below as well.* This field is required.
13
For Trips to BrickEd ONLY: Are you interested in an additional 30 minutes in our Activity Zone time for your classes/group?* This field is required.Each trip to BrickEd has built in time for students in our activity zone, but sometimes you would like more! For only $1.50 per child more students can extend their fun!
YESNO
14
Approximate Number of Students for Field Trip* This field is required.Invoice will be determined by final headcount one week prior to trip and no changes will be made after that date. Our minimum number of students to fully book your field trip will be at least 20 students. A minimum charge of $220 including tax will be assessed if under 20 students. The final number of students does not have to be decided until 3 days prior to the trip date.
15
Will you be having students eat lunch at our facility?* This field is required.
YESNO
16
Please list the financial person that the quote/invoice need to be sent to?* This field is required.
First Name
Last Name
17
Email for financial person receiving the quote/invoice* This field is required.
example@example.com
18
Have you visited BrickEd® before?* This field is required.
YESNO
19
How did you hear about BrickEd®? (Select all that apply)* This field is required.
Social Media (Facebook, Instagram, etc.)
Website/Search Engine
Word of Mouth
School/Teacher Referral
Community Event
Other
20
Terms and Conditions* This field is required.
Should be Empty: