In-class Field Trip Reservation Form


		In-class Field Trip Reservation Form

Please use this form to indicate your preferred Field Trip date(s) and topics(s). Once we have received your request, we will call you to finalize details and send you a confirmation letter. Thanks for choosing Mad Science! Please do not submit this form to ask a question only. Send your questions to (503) 230-8040 .
NEW CUSTOMER*
*If you are a new customer fill out the following information:
School or Organization:
Address:
City, State, Zip:
Contact Name:
RETURNING CUSTOMER**
**If you are a returning customer fill out the following information:
School or Organization:
City:
Contact Name:
CONTACT INFORMATION
It is important that we be able to contact you to finalize details. Please provide a phone number and the best time to contact you. Your email address is used to send you a confirmation letter.
Day Phone:
Cell Phone:
Best time to call:
Email:
Best method of contact:
FIELD TRIP DATE
1st Choice:
2nd Choice:
3rd Choice:
Additional Information:
FIELD TRIP LOCATION

FIELD TRIP TOPIC
Visit our DESCRIPTIONS page to help you choose a topic!
	Check this box if this is an "Earth Day Special." See below for "Earth Day Special" limitations.

FIELD TRIP SCHEDULE

Before you schedule your field trip(s) there are a few things to remember:

Our Mad Scientist is being sent to lead your students on an exciting, hands-on, in-class field trip, Classrooms with more that 20 students require the classroom teacher to remain in the room to provide assistance.
Field Trips are 1 hour long. For multiple field trips on the same day allow at least 15 minutes between each session.
Pre-K Field Trips are 45-minutes long. For multiple field trips on the same day allow 15 minutes between each session
Wait time between sessions of 30 minutes or more will be charged a wait fee of $20 per hour.
Generally, field trips are not available after 1:00 p.m.on school days.
Chem in a Flash, Electricity, Labworks, Machines, Optical Illusions, Space the Final Frontier, Super Sticky Stuff are subject to an additional $1.00 per child materials fee.
Travel fee applies to all locations outside of the Portland and Vancouver city limits.

Start Time
Teacher/Grade
# of students Room #

1.

2.

3.

4.

Additional scheduling details:


"EARTH DAY SPECIAL" LIMITATIONS

The following limitations apply to "Earth Day Special" field trips only.

Earth Day field trips have limited availability, please book early!
$109 price is valid only for the field trips specified. See our Descriptions page for complete list.
Field trip must be completed between April 1, 2009 and April 30, 2009.
Earth Day Special price expires on April 1, 2009.
Earth Day Special price cannot be combined with any other discount method including Mad Science Thank You Coupons.
Field trips are regularly priced at $139.



This form is to reserve an in-class field trip. Clicking on the submit button will transfer your information into a booking.

Please do not submit this form for inquiries or questions only.
Send your inquiries to (503) 230-8040