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2008-2009 Online School Field Trip Program Reservation Form



Please review the Field Trip Program Policies on our web site ( http://www.thehealthmuseum.org ) before completing this form.  By submitting this form, you and any other attending adult representatives agree to these policies

* indicates a required field

Site Coordinator's (your) Name): *
School Name * District: *
County * ESC Region
School Address *
school address line 2
City  * State *
Zip  *
School Phone * School Fax *
School (your) email *
Best Time to Reach by Phone * Cell Phone Number
List any special needs
 
Please select the grade level(s) which will be attending the field trip:
 
A minimum of 15 students is required for field trip reservations. We admit one (1) free chaperone for every ten (10) students.
# Students * # Chaperones *
 
DESIGN-YOUR-OWN FIELD EXPERIENCE
All field trips include admission to our permanent exhibitions and a 4D film experience in the McGovern Theater.
 

Step 1

Choose a date and start time for your field trip
 

Choose three possible dates for your visit (September 2008 - May 2009). *

Click on the calendar control to choose the date
 
Choose up to three start times: *
 
First Choice:
 
Second Choice:
 
Third Choice:
 
 

Step 2(Optional)

Customize your learning experience by adding a special exhibition, a dissection demonstration, an interactive science class or dissection lab, or a combination of these options to your field trip program.
 

Special Exhibitions
(30 minutes, add $1/student)
 
Dissection Discovery Zone
(30 minutes, add $2/student)
Grades 3 and up
 
Interactive Science Classes
(60 minutes, add $3/student)
Grades 3 and up
Grades 3-5
Grades 6-8
Grades 9-12
 
Dissection Labs
(60 minutes, add $4/student)
Grades 5 and up
 

Step 3

Decide if you would like to pre-order souvenir bags or visit the Amazing Body Store during your field trip.
 
  souvenir bags. ($2 each)
  Please choose one:
 
I have a promotion code:
 
Please submit your reservation to The Health Museum Reservations Coordinator at least two weeks before your preferred field trip date. A confirmation letter will be sent to you within 2 business days.
 
Questions? Contact the School Programs Reservations Coordinator at 713-521-1515 ext. 121 or reservations@thehealthmuseum.org
 
  © Copyright  2008 The Health Museum