| * Required fields |
| |
| Today's Date: September 6, 2008 |
| |
Program or Tour Requested: (select one) *  |
| |
|
A Child's Life in the 1890's
(Grade 2, $4 per student) |
|
Experience Adobe Days
(Grade 4, $7 per student) |
|
Experience Victorian Days
(Grade 3, $7 per student) |
|
Explore the Peralta Adobe & Fallon House
(Grades 3 - 4, $3 per student) |
|
Gold Rush Adventure Kit
(Grade 4, $125 rental fee) |
|
Historic Transportation Experience
(Grade 2, $3 per student) |
|
History Hike
(Grades 5 - 6, $4 per student) |
|
History Park Tour
(Grades 3 - 12, $3 per student) |
|
Immigration
(Grade 4, $4 per student) |
|
People at Work
(Grade 3, $4 per student) |
|
Peralta Adobe & Fallon House Tour
(Grades 5 - 12, $3 per student) |
|
School Days in the 1890s
(Grades 4 - 5, $5 per student) |
|
Valley of Heart's Delight
(Grades 3 - 4, $4 per student) |
|
Victorian Family Life
(Grades 3 - 5 , $125 per class) |
|
Westward Ho!
(Grade 5, $7 per student) |
| |
| Preferred Dates and Times of Visit |
| Please indicate 3 windows of availability (e.g., any weekday Sept. - Dec.) for your program. You may type up to 32 characters in each box. We will do our best to accommodate your requests, as programs are reserved on a first come, first served basis. |
| |
| |
1st preference:
|
| |
2nd preference:
|
| |
3rd preference:
|
| |
| Group Information |
| |
| |
Name(s) of all Teachers coming: *
|
| |
Teacher Phone(s): *
|
| |
Teacher Email(s):
|
| |
Class Details |
| |
Grade Level:
|
| |
Number of Classes:
|
| |
Number of Chaperones in each Class:
|
| |
Number of Students in each Class:
|
| |
School Details |
| |
Name:
|
| |
Street Address:
|
| |
City:
|
| |
Zip Code:
|
| |
Phone Number:
|
| |
Fax Number:
|
| |
Contact Details |
| |
Role: Teacher: Parent: |
| |
Name:
|
| |
Daytime Phone Number: (include area code)
|
| |
Evening Phone Number: (include area code)
|
| |
Email Address:
|
| |
| Tour Information |
| |
| |
Will you visit O'Brien's Candy Store at History Park?
Yes: No:
(If yes, add 45 minutes per class to your field trip schedule) |
| |
Will you visit the Museum Store at History Park?
Yes: No:
(If yes, add 45 minutes per class to your field trip schedule) |
| |
How will your class travel to the museum?
Auto: School Bus: Mass Transit: Other: |
| |
Do your students have any special needs?
Yes: No:
If yes, please explain:
|
| |
| Do you receive HSJ's School Program Brochure over the summer? If not, we will be happy to mail it to your home address rather than your school. |
| |
| |
Teacher Name:
|
| |
Home Street Address:
|
| |
City:
|
| |
Zip Code:
|
| |
|
|
