Field Trip Application Form

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* Teacher/Leader:

* I am applying for the following season (choose only one)
Please see table below for application deadlines and teacher contact dates

	SUMMER (mid-June through mid-September)
	AUTUMN (mid-September through January)
	WINTER/SPRING (February through mid-June)

Co-Teacher/Leader
(Required for two or more classes)

* Field Trip Coordinator/Contact Person

* School/Organization

* Street Address

* City

County

* State

* Zip:

* Contact Info Please check the best way(s) to contact you.

Office Phone

Cell Phone

Office Phone:
Example: 123-456-7890

Office Phone Extension, if applicable (numbers only)

Cell Phone
Example: 123-456-7890

* Enter your e-mail address here. You will receive a copy of your submission via e-mail.
Enter a valid email address.
Example: name@domain.com

* Grade Level

* Number of classes (numbers only)

* Number of Students (numbers only)

* Number of Adults (numbers only)

* Are you a 3rd grade teacher enrolled in the Kids Healthy Outdoor Challenge (KHOC) program?

	Yes
	No

* Program Location of Choice

Programs Requested: (For details about these programs, download program summary in PDF format under "Interpretive Centers" section at the bottom of this form)

* 1st Program Choice:

2nd Program Choice (optional): Please Note - 2nd Program Choice MUST BE at same location as 1st Program Choice!

Related Studies/Currently Studying

Applicant Notes:
Please specify preferred dates and any other special needs.

* Student Photos:
I grant permission to allow photos to be taken of my students (program photos are sometimes taken for publicity purposes).

	Yes
	No

* What type of transportation do you plan on using?

* Captcha

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