Field Trip Request

Field Trip Request Form 2023-2024

Name*
First Last
School/Group Name:*
Complete Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone*
Contact Phone (During Field Trip)*
Email*
Confirm Email*
Grade/Age of Children:*
Number of Children (10 MINIMUM, $10 each):*
Number of School Staff Chaperones (free)*
Number of Additional Adults Chaperones ($8 for non-staff)*
List 3 dates, in order of preference, for your visit.*
How did you hear about Gilbert House Children's Museum?*
If you plan to pay with a purchase order, please check the box below, and we will email you an invoice.*
- We'll pay via purchase order
- We'll pay via another method (cash, check or credit card)
Field Trip Contract (Please review all the information below and mark each box to show that you agree and understand):*
- Payment is due on or before the date of your visit. GHCM accepts cash, check, credit card, or purchase order. If using a purchase order, payment is due within 30 days of receipt of invoice. If your field trip number changes after your final payment, we cannot refund amounts under $20.
- One adult is required for every 5 children. School Staff Chaperones are admitted free. Other Adult Chaperones are $8 each. Groups that do not meet the 1:5 ratio will be charged at regular daily admission rates, rather than the group rate.
- Instructional assistants for special needs children are allowed free admission. Please indicate if your group will include instructional assistants for this purpose in the comment box.
- A cancellation fee of 50% of the trip fee will be assessed for trips rescheduled or cancelled with less than 48 hours’ notice. No fee will be charged in the event of Salem-Keizer or Contact’s School District closures due to inclement weather, provided you notify us as soon as possible.
- At any time, any of our exhibits may be closed for maintenance or updating.
- There is no on-site bus parking. In your confirmation email, you will be provided with a map showing a city-approved off-site parking lot. We do have a loading/unloading zone adjacent to the museum. Individual parking is available under the bridge directly in front of the museum, in the North Parking Lot of Riverfront Park, and metered parking is available at $1.50 per hour in the lot adjacent to the bridge parking lot.
- Wristbands for admittance will be mailed to your school two weeks prior to your trip. Unused wristbands can be returned to the front desk for a refund the day of your trip. Additional wristbands can be purchased at regular admission cost ($14).
Electronic Signature for Field Trip Contract Above:*
Comments:

Field Trip Request Form 2023-2024

Admission