About Mt. Shasta Museum

Test Form:

* required fields

Field Trip Request Form

Teacher Information

Enter the name (first and last), email and phone number for up to 3 teachers participating in your field trip:

*name: *email:
*phone:

 name:   email:   phone:

 name:   email:   phone:

School Information

*school: *address:
*phone:

*we are a "title 1" school: yesnonot sure

Attending Student Grade Levels

*Select all that apply:

kindergarten5th10th1st6th11th2nd7th12th3rd8thcollege4th9thgraduate

Chaperone/Student Count

*# of chaperones:
*# of students:

Preferred Date/Time

Important! Field trips can only be scheduled on our CLOSED days: Tuesdays & Wednesdays.

*first choice date: *time:

*second choice date: *time:

Accommodations

If you would like assistance finding accommodations for any of your students, please describe below (255 character max).

Acknowledgements

*I understand that the fee for field trips is $1/person.

*If I need to cancel my field trip, I must contact the museum no later than 24 hours before my visit.