Illinois Field Trip Registration Form Please complete the following request for Illinois school and community group field trips. Field trips and student programs are only available for groups of 15 or more that register 14 days prior to the visit date. When you are finished, click Submit to send your request to the Reservations Office. You will receive an immediate email verification of your reservation request. Once we receive your request, we will verify availability and create a group reservation. We will send confirmation of that group reservation to you via e-mail within two days. If we are unable to accommodate your request, we will contact you via telephone and/or email to discuss alternatives for your group. Please note that pre-registration for field trips is required. Groups that come to the Museum without pre-registration will not be admitted. If you have questions about your reservation request or would like to speak with someone in the Reservations Office, please call (312) 665-7500. Field Trip Coordinator InformationPlease provide your contact information here. First Name (required) Last Name (required) Preferred E-mail Address (required) Personal Telephone (xxx) xxx-xxxx Day of Field Trip Contact InformationPlease provide the contact information of one adult who will be present on the field trip. Day of Field Trip Contact Name (required) Cell Phone Number (required) Please provide a cell phone that can be reached during the field tip. (xxx) xxx-xxxx School/Organization Information School/Organization Name (required) Street Address (required) City (required) State (required) Zip (required) Telephone (required) (xxx) xxx-xxxx Fax (required) (xxx) xxx-xxxx Group Information Grade Level (required) DaycareFine ArtsPre-KK1st2nd3rd4th5th6th7th8th9th10th11th12thSpecial EducationELLDual LanguageGiftedHome School GroupOther * For Windows: Hold down the control (ctrl) button to select multiple options * For Mac: Hold down the command button to select multiple options Number of Students (required) Number of Chaperones (required) Must meet Required Chaperone Ratio: Students in grades pre-K-5: minimum of 1 adult chaperone for every 5 students, maximum of 1 adult for every 3 students; students in grades 6-12: 1 chaperone for every 10 students. Age Range (required) Please describe the range of ages of the students in your group. (e.g. 6-8 years old) Special Needs Please describe any special needs (e.g. wheelchair) your students may have. Special Needs Chaperones - None -012345678910 Please identify the number of extra chaperones who will accompany the special-needs students (in addition to those listed above). Day of Visit 1st Choice (required) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2015201620172018 2nd Choice Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2015201620172018 3rd Choice Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2015201620172018 Arrival Time (required) Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Departure Time (required) Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Museum Hours are 9am-5pm, contingent upon time of year. Last admission is at 4pm. Please check your school calendar to avoid scheduling visits on holidays or in-service days.