Virtual / Outreach / Trunk Request Form

Virtual Field Trip, Outreach Programs, and Time-Travel Trunk Rental Request Form
Contact Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
School / Group Name
School / Group Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What Program(s) Would You Like To Schedule?

Outreach Programs have a maximum capacity? What other information here?
We are interested in an . . .

Outreach - Programs, Dates, and Times

More information here
We are interested in scheduling a . . .
Please include the teacher names for all teachers attending the programs, including prefixes such as Miss, Ms., Mrs., Mr., Mx., etc.
Preference 1

MonthDayYear
Tuesdays, Wednesdays, Thursdays, and Fridays are the best days
Preference 2

MonthDayYear
Tuesdays, Wednesdays, Thursdays, and Fridays are the best days
Preference 3

MonthDayYear
Tuesdays, Wednesdays, Thursdays, and Fridays are the best days
Number of classes / presentations
Maximum of 4 presentations in a single day
Start times of presentations / classes
Any additional information about our visit to your site?
Parking, classroom numbers, location of presentation, moving between rooms or stationary, etc.

Outreach - Head Counts and Accommodations
Number of Students (total)
Number of Teachers / Staff (total)
Do you have any special requests or accommodations for your field trip? This could include (but is not limited to):

- an end-time of programming

- other sites / visits scheduled for your field trip (ex. the Railroad Museum)

- transportation that will affect scheduling

- participants with disabilities

- participants enrolled in ESL programs

- splitting your group across multiple days

- scheduling breaks and/or lunches

- any other accessibility concerns
If you do not have any special requests or accommodations, please write "no accommodations needed."

Virtual - Programs, Dates, and Times
We are interested in scheduling a . . .
Please include the teacher names for all teachers attending the programs, including prefixes such as Miss, Ms., Mrs., Mr., Mx., etc.
Preference 1

MonthDayYear
Mondays, Tuesdays, Wednesdays, and Fridays are preferred.
Preference 2

MonthDayYear
Mondays, Tuesdays, Wednesdays, and Fridays are preferred.
Preference 3

MonthDayYear
Mondays, Tuesdays, Wednesdays, and Fridays are preferred.
Number of classes / presentations
Maximum of 4 presentations in a single day
Start times of presentations / classes

Virtual - Head Counts and Accommodations
Number of Students (total)
Number of Teachers / Staff (total)
Number of Screens
Do you have any special requests or accommodations for your field trip? This could include (but is not limited to):

- an end-time of programming

- other sites / visits scheduled for your field trip (ex. the Railroad Museum)

- transportation that will affect scheduling

- participants with disabilities

- participants enrolled in ESL programs

- splitting your group across multiple days

- scheduling breaks and/or lunches

- any other accessibility concerns
If you do not have any special requests or accommodations, please write "no accommodations needed."

Travel Trunk Rental
Preference #1 - Pickup

MonthDayYear
Date
Preference #1 - Drop off

MonthDayYear
Date
Preference #2 - Pickup

MonthDayYear
Date
Preference #2 - Drop off

MonthDayYear
Date
Preference #3 - Pickup

MonthDayYear
Date
Preference #3 - Drop off

MonthDayYear
Date
Do you have any special requests or accommodations for your field trip? This could include (but is not limited to):

- an end-time of programming

- other sites / visits scheduled for your field trip (ex. the Railroad Museum)

- transportation that will affect scheduling

- participants with disabilities

- participants enrolled in ESL programs

- splitting your group across multiple days

- scheduling breaks and/or lunches

- any other accessibility concerns
If you do not have any special requests or accommodations, please write "no accommodations needed."

Please note that this is not a confirmation. This request form does not guarantee you the program, date, or time requested above. Programs are confirmed once you receive an invoice. Payment is due 1 week prior to the field trip date.
We require a 1-week notice to cancel or reschedule programming. We will not issue a refund for cancellations less than 1 week from the original field trip date. If cancellation occurs less than 1 week before a scheduled program, you must receive a cancellation confirmation from the Education Department (shm-education@sachistorymuseum.org). No Calls, No Shows will be charged the full balance in addition to a $50 fee.
Should be Empty:

Virtual Field Trip, Outreach Programs, and Time-Travel Trunk Rental Request Form