2. Monroe Science Center School Trip Request Form

3. 
5. First Name:*
6. Last Name:*
8. School/Organization:*
10. Contact/School Mailing Address:*
12. City:*
13. State:*
14. Zip Code:*
16. Email:*
17. Contact/Organization Phone:*
19. Grade Level Attending:*
    -- Select One --Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeElementary (Mixed Grades)6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeHigh School (Mixed Grades)
20. Cell Phone:*

    In case of emergency while you're on site

22. Number of Adults/Chaperones:*
23. Number of Students over 2 Years of Age:*
25. Number of Children Under 2 Years of Age:*
26. Method Of Transportation:

    1. Buses
    2. Vans
    3. Personal Vehicles
28. Note: Groups of over 100 students must choose visit dates on Tuesdays.*

    1. I understand that if my group has over 100 students, I must request my visit to be on a Tuesday.
30. Visit Date First Choice*
    Visit Date First Choice

    Visit Date First Choice
31. Visit Date Second Choice:*
    Visit Date Second Choice:

    Visit Date Second Choice:
32. Visit Date Third Choice:*
    Visit Date Third Choice:

    Visit Date Third Choice:
34. Please read and check the box for understanding:*

    1. Request Forms must be submitted at least two weeks before your requested visit date.
    2. Payment is required prior to your scheduled arrival or before your group may enter the science center. If payment is not received, the Monroe Science Center reserves the right to cancel your group visit and the group rate will no longer apply.
    3. All children and chaperones not paid for prior to the group’s arrival will be charged for a general admission price of $10 each at check-in.
    4. We require one adult (18 years old or older) for every 10 children (under 14 years old). There are no exceptions to this rule.
    5. Requests for Tuesdays have a minimum admission requirement. Groups booked will forfeit their right to re-entry.
    6. All cancellations must be submitted via email or phone. If payment has already been made, a credit in the payment amount will be retained on the group's account to apply towards a future visit within one year of the scheduled visit.
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field