Field Trip Request Form Field Trips @ the Connecticut Science Center Please make a selection: * I am ready to book my Field Trip Submitting this form will result in a booking. If you would like a quote, please reach out to the Reservation Center at reservations@ctsciencecenter.org or call us at (860) 520-2150 What type of group are you booking for? * School Group: Public/Private PreK-12 school, or accredited early childhood program Youth Group: After School Program, Day Care, Parks and Recreation, Summer Camps, Scout Groups, etc. College Group: Accredited post high-school program (College, Nursing Program, Technical School, etc.) Adult or Senior Group PWD Group: Groups of person with disabilities If your group does not fit into any of these categories please call the Reservation Center at 860-520-2150. We are happy to help! Organization Information Organization Name * Organization Address * Organization Address Organization Address Organization Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Organization Phone * Grade Level * Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6-8 Grade 9-12 This does not apply to my group How many classes will you be bringing? * Your Information Title * Mr. Mrs. Ms. Mx. Dr. Name * Name First First Last Last Phone #1 * Phone Type #1 * Work Mobile Phone #2 Phone Type #2 Work Mobile Email * What is your title? * Educator Administrator Parent OtherOther Will you be attending this field trip as the group leader? * Yes No If no, please fill out the group leader's contact information below Secondary Contact Information Title * Mr. Mrs. Ms. Mx. Dr. Name * Name First First Last Last Phone Number * Email * Field Trip Logistics Date and Time Selection Closed: Monday-Tuesday Open: Wednesday-Friday, 9:00 am-4:00 pm Current Traveling Exhibition: Science Fiction, Science Future First Choice Date * Second Choice Date * Third Choice Date * Arrival and Departure times are in 15 minute intervals between 9:00 am-3:00 pm I can arrive at the Science Center as early as: * 121234567891011 : 00153045 AMPM I can depart the Science Center as late as: * 121234567891011 : 00153045 AMPM Transportation and Parking How will your group be arriving? * Bus Cars/Vans Both OtherOther How many buses? * There is no on-site parking at the Connecticut Science Center. Off-site Bus Parking: $12.00 per bus at the Connecticut Convention Center next door. Exact cash or credit card will be accepted directly at the parking log. Directions to the lot will be provided to bus drivers upon arrival. How many cars/vans? * Garage Parking (cars or vans under 8'2"): $3.00 for the first hour, $2.00 for each additional hour Participant Information Please provide the approximate number of youth and adults that will be attending. Your headcounts may be adjusted at any time before you submit payment. # of Youth (ages 3-17) * # of Adults (18+) * To ensure proper student supervision, the cost of 1 chaperone for every 8 students is automatically added onto your reservation # of 1:1 Student Aides Student Aides are 1:1 with a student who could not come to the Science Center without their assistance. Teacher helpers/student teachers are not counted as aides. # of Youth (ages 3-17) * # of Adults (18+) * # of 1:1 Aides * Please list any special accommodations or requests for your group Group Pricing General Admission (Required) $14.00 per person $16.00 per person A 15 person minimum is required to qualify for the youth group rate. Scout Groups only require a minimum of 10. $16.00 per person Persons with disabilities (PWD) receive an admission rate of $16.00 per person. If an individual requires one-to-one assistance throughout their visit, their accompanying staff member will be admitted at no charge. Any additional persons or staff who are not 1:1 with a student/client will receive the rate of $16.00 per person. Adult/Senior Group Pricing * General Admission: $16.00 per adult 60 Minute Highlights Tour: $125.00 per 15 adults- No re-entry to exhibits after tours General Admission + 60 Minute Highlights Tour: $16.00 per adult + $50.00 per 15 adults Senior groups are exempt from the 15 person minimum requirement, however, a reservation is still required. Field Trip Activities - Lunch It is free to reserve space in our lunch room. If indoor lunch room space is fully booked, you have the option to eat outside on the Science Center's plaza or on the Riverfront Plaza which is directly adjacent to the Science Center (weather permitting). Will you be eating your lunch during your field trip? * Yes, my group will would like to use the indoor lunch space Yes, my group would like to eat outside on the Plaza No, we will not be eating lunch during our trip Field Trip Activities - 3D Movies and Theater Presentations Would you like to view a 3D Movie or a Stage Show? * 3D Movie Stage Show No 3D Movie Selection * Animal Kingdom Dream Big Extreme Weather Mysteries of the Unseen World Train Time- 2D $6.00 per person Stage Show Selection * Extreme Air (not available July - August) Global Soundscapes (not available July - August) $7.00 per person Field Trip Activities- Discovery Center Programs Would you like to participate in educational programming? * Yes No 20 minute Butterfly Encounter Programs$6.50 per person, per program 45 minute Classroom Program$9.00 per person, per programEach of these programs models one classroom period of inquiry-based hands on investigations. Programs align with the Next Generation Science Standards What grades are you booking for? * Grades K-2 Grades 3-5 Grades 6-8 Grades 9-12 Please select the grade band(s) that will be participating in the program. For more details about our programs, please follow this link. Grades K-2 * On a Roll (K-PS2.A,B) Animal Appetites (K-LS1.C)) Habitats and Homes (K-ESS2.D) Sound Breakdown (1-PS4.A) Tricky Traits (1-LS3.A) Facts of the Matter (2-PS1.A,B) Pollen-Nation (2-LS2.A) Wash Out! (2-ESS2.A) Butterfly Spy No, thank you. Grades 3-5 * Crash Lab (3-PS2.A) All Eyes on Evolution (3-LS4.B) Storm Trackers (3-ESS2.D) Make it Magnetic (4-PS4.A) Making Waves (4-PS4.A) Choose Your Chompers (4-LS1.A) Streaming Away (4-ESS2.A) Powerhouse (4-ESS3.A) A Chem-Mystery (5-PS1.B) Oceans in Motion (5-ESS2.A) Wild Wings Energy Through Time and Space (4-PS3.A,B, 5-ESS1.A) No, thank you. Grades 6-8 * Gene-ius of Taste (MS-LS3.A) Tectonic Travels (MS-ESS1.C) Roller Coasters (MS-PS2.A) Refraction Action (MS-PS4.B) Reason for the Seasons (MS-ESS1.B) Horsin' Around with Evolution (MS-LS4.B) Mighty Electromagnets (MS-PS2.B) Butterfly Biomes (MS-LS2.A) Energy Through Time and Space (MS-PS2.B, MS-ESS1.B) No, thank you. Grades 9-12 * Gene-ius of Taste (HS-LS1.A) Conserving the Cottontail (HS-LS4.C,D) Energy Through Time and Space No, thank you. Additional Information - Survey What prompted you to book with the Connecticut Science Center? I have booked a field trip or program in the past My school has a partnership with the Science Center I'm a member of the Science Center I have visited with my family/friends It was recommended to me by a colleague I received a Science Center email I received a Science Center mailing I received an Educator Guide I have a referral code OtherOther Referral Code * Payment Information Full payment is required prior to your visit. If you are unable to make payment in advance, please contact the Reservation Center to make alternate payment arrangements. Please note: Corporate memberships and Science Center memberships are not applicable for field trip admission. Is your field trip being funded by a grant or contract? * Yes No Please indicate the grant or contract name below * Submit If you are human, leave this field blank.
