Wagner Free Institute of Science: Field Trip Registration Form
Please fill out the information below with as much information as you have available. If you would prefer to have information sent to you via the post, please indicate so in the comments section. Email reservations( at) wagnerfreeinstitute (dot) org with any questions.
Contact Name
*
Prefix
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Organization
*
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Number of Students (G2+ = 60 max, PreK-G1 = 30 max)
*
Number of Adults
*
Planned Date
-
Month
-
Day
Year
Date
Planned Time (Tu-Th 10:00-11:30 or 12:30-2:00, and Friday Mornings)
10:00-11:30am
12:30-2:00pm
Grade Level
*
Lesson Topic
*
Please Select
Endangered Species (G4+)
Evolution (G4+)
History of the Wagner (G4+)
Human Body Systems (G4+)
Urban Ecology (G4+)
Animal Adaptations (G2+)
Birds (G2+)
Butterflies & Moths (G2+)
Dinosaurs & Fossils (G2+)
Food Chains (G2+)
Insects & Other Arthropods (G2+)
Mammals (G2+)
Ocean Life (G2+)
Reptiles & Amphibians (G2+)
Rocks & Minerals (G2+)
Skeletons (G2+)
Animal Babies (PreK-G1)
Animals in Winter (PreK-G1)
Day/Nighttime Animals (PreK-G1)
Dinosaurs (PreK-G1)
Insects (PreK-G1)
Sort Like a Scientist (PreK-G1)
Will Decide Later
Additional Comments
Please provide details if any group members have special needs or require special assistance so that we can be prepared for your visit or any other concerns/questions.
*
I have read and agree to the
Terms and Conditions on the Policies Page.
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