Field Trip Registration Form

8695 Broadway, Merrillville, IN 46410
(219) 853-2420

Field trips begin at 10:00 am and end by 1:00 pm. Facilities are available for lunches brought from home.
Multiple days may be required depending on number of classes being registered.

Contact Name *

Email Address *

School Name *

School Address *

City / State *

Grade Level *

# of Classes *

School Phone Number *

Cell Phone *

Number of Students *

Please select (√) a program listed below Please select only ONE *

Please provide three (3) possible dates for your field trip as they are scheduled on a first registered, first scheduled basis.

1^st Date Choice *

2^nd Date Choice *

3^rd Date Choice *

School Start Date *

Last Day of School *

Fall Break Start Date *

Fall Break End Date *

Winter Break Start Date *

Winter Break End Date *

Spring Break Start Date *

Spring Break End Date *

Additional information to assist scheduling