HFPG Summer Field Trip Request 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 * 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 * 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 Open: Starting July 1, open 7 days a week, 9:00 am-4:00 pm Current Traveling Exhibition: Under the Canopy 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. Please list any special needs or requests for your group 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 bring their own individual lunches Yes, my group would like to eat outside on the Plaza No, we will not be eating lunch during our trip Field Trip Activity - 3D Movie Would you like to view a 3D Movie or a Stage Show? * 3D Movie No 3D Movie Selection * Animal Kingdom (3D) Jane Goodall: Reasons for Hope (2D) If you are human, leave this field blank. Submit
