Nature-based Virtual Field Trip Booking Request Form

School Contact Information and Billing Address

School Name*

School Phone Number*

School Address*

School County*

School District*

Please provide information for Billing purposes.

Billing Contact Name*

Billing contact email address*

Phone Number for the Billing contact*

Billing Address - please complete if it is different than the school address.

ABOUT OUR FEES

Given this time of financial hardship for our schools and our organization, we are offering a new sliding scale fee structure aimed to provide greater flexibility in choosing a price that is within your school’s budget.

Tier A: The fee is set 25% higher than what it costs to run the program
Tier B: The fee is set to cover 100% of the program costs.
Tier C: The fee is set at 25% less than what it costs to run the program.

Fee per Virtual Field Trip Program: Tier A-$94 | Tier B-$75 | Tier C-$56

Please choose a fee Tier for billing.*

No Selection Tier A Tier B Tier C

Teacher Contact Information

First Name*

Last Name*

Phone Number*

Email Address*

Would you like to be added to our email contact list and stay informed about future programs and activities at the Hitchcock Center?

Yes No

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Field Trip Selection

Grade Level

Total number of students -limit of 22 per class*

Which Virtual Field Trip are you Requesting*

Please note that Monday - Fridays (10:00am, 11:00am, 1:00pm) and Fridays (10:00am) are currently the time and days available for our Virtual Field Trips.

First Date Choice*

Second Date Choice*

Desired Start Time*

10:00 am 11:00 am 1:00 pm

What format do you use for your Virtual teaching?

Please list any questions or special requests you may have.

I understand that someone from the Hitchcock Center will be in touch to discuss my request further and submitting this form does not immediately book a program. Final pricing will be reviewed prior to confirming any request. I consent to having this website and the Hitchcock Center store my submitted information so they can respond to my inquiry.

Cancellation Policy: If you decide to cancel your trip you must do so 1 week before the date of the trip. If you cancel later, you will be responsible for the full payment.

I have read and understand the above statements.*

Submit

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Thank you for signing up, one of our educators will be be in touch to confirm your dates and to provide the links necessary for the field trip.