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
Are you a Title 1 school?
Great News!

The Sacramento History Alliance provides a limited number of scholarships for Title 1 schools. Scholarships cover 1 program for 1 class of 35 students. If there are multiple classes attending the field trip, each needs to be accounted for in the scholarship form. Chaperones beyond the number of free adults provided (approximately 1 per 8 students) are not covered by scholarships and are charged an additional fee. For more information, please visit www.sachistorymuseum.org/field-trips/

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
2 digit month, 2 digit day, 4 digit yearTuesdays, Wednesdays, Thursdays, and Fridays are the best days
Preference 2

MonthDayYear
2 digit month, 2 digit day, 4 digit yearTuesdays, Wednesdays, Thursdays, and Fridays are the best days
Preference 3

MonthDayYear
2 digit month, 2 digit day, 4 digit yearTuesdays, 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
2 digit month, 2 digit day, 4 digit yearMondays, Tuesdays, Wednesdays, and Fridays are preferred.
Preference 2

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMondays, Tuesdays, Wednesdays, and Fridays are preferred.
Preference 3

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMondays, 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
2 digit month, 2 digit day, 4 digit yearDate
Preference #1 - Drop off

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preference #2 - Pickup

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preference #2 - Drop off

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preference #3 - Pickup

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preference #3 - Drop off

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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.
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Virtual Field Trip, Outreach Programs, and Time-Travel Trunk Rental Request Form