POD Field Trip Booking Form | Springfield Museums

Group Coordinator
Name*
Email*
Cell Phone*
Would you like to receive Educator Text Alerts from the Springfield Museums?*
- Yes
- No
Expect 3 messages regarding your field trip, plus an additional 3-4 messages per year. Message and data rates may apply. Text STOP any time to cancel.
School Information
If applicable.
School Name
Address
Street Address Address Line 2 City State ZIP Code
School Phone

Additional Information
Will your group bring lunches to eat at the Springfield Museums?
- Yes
- No
Would you like to be contacted by our Blake House Cafe manager regarding boxed lunches?
- Yes
- No
How would you describe your students' learning style?
Are there any sensory concerns (tactile, noise, ability to sit for a class, etc) that we should be aware of?
What topics are you studying and how do they pertain to the programs and tours you have chosen for your field trip?*
Is there anything else we should know about your students to ensure you have the best experience at the Springfield Museums?
Accessibility/Special Requests (Student allergies, disabilities and/or mobility needs)
Would you like to receive our monthly Educator E-Newsletter?
- Yes
- No
How did you hear about us?
Unless otherwise noted by the visiting school educator, submitting this form gives consent to the use of photographs/videotape taken during the course of a school program visit for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources).*
- Agree
- Decline
- Send me further information
The visiting school educator does this with full knowledge and consent and waives all claims for compensation for use, or for damages. If a single student or multiple students may not be photographed, please inform the school program coordinator.

Group Coordinator