Clone of Visit Request Form

1

Main Contact Name* This field is required.

2

Main Contact Email* This field is required.

3

Main Contact Phone Number* This field is required.

4

Day-of Contact Phone Number* This field is required.

5

School* This field is required.

6

Group DetailsDescription optional

7

Number of Participants* This field is required.We require a 12:1 student-adult ratio.

Adults

Students

8

Grade* This field is required.

9

My group is from a Title I school* This field is required.

YESNO

10

Which learning styles work best for your group(s)?* This field is required.

Verbal discussion

Drawing

Writing

Manipulatives and tactile opportunities

Movement activities

11

Our group includes:

Students who might be sensory sensitive

Students who are deaf or hard of hearing

Students with vision loss

Students with intellectual disabilities

Students who are primarily proficient in a language other than English

Students who are non-verbal

Students who have low mobility

Students who are non-readers

Students who use a wheelchair

12

Below is a list of accommodations that we can provide. Please check any that apply.

Spanish translated materials

Visual aids

Large print handouts, printed details of artworks

Tour routes that use elevators and ramps

Voice amplifier for tour leader

Extra time for tasks and responses

Unsure at this time

13

Is your school interested in eating lunch at LBMA on the day of the field trip? Our lunch timeslot is from 11:30 am - 12:00 pm.

YESNO