Field Trip Request Form - Kiewit Luminarium

Step 1 of 5

Information About Your Visit

1. Field Trip Dates and Times

Visit our availability calendar (opens in a new tab) to see available dates and arrival times.

Arrival Date (1st choice)

Departure time

Arrival Date (2nd choice)

Departure time

2. Would you like to have our Luminator staff guide your group for the first 30 minutes of your field trip to support your instructional goal(s)? Yes, I would like to have Luminators facilitate the first 30 minutes of my trip. No, our teachers will facilitate exhibits without Luminator support.

3. State the main instructional goal(s) of your field trip and/or related standard(s) or topic(s)

Select all that apply.

Grade-level science standards Grade-level mathematics standards Grade-level social studies standards Critical thinking and problem solving with others Fostering collaboration and communication amongst students Other

4. Will you need space for your students to eat sack lunches that you bring? Yes – Please schedule us to eat inside Maybe – Outside preferred, but we need an indoor backup No – No lunch space needed regardless of weather

5. Is your organization tax exempt? Yes No

6. What percentage of your students receive free or reduced lunch? Optional

Select one option. Select it again to clear your answer.

Under 40% 40-75% Above 75%

7. You will be invoiced after your visit, please select your payment method: Credit Card Mailed Check ACH

Step 2 of 5

Organization and Contact Information

Organization Information

Type of School or Organization

School Name

School District

Select a suggested district or type another district name.

School Mailing Address

School City

School State

School Zip Code

Contact Information

Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone Number (include area code)

Primary Contact Email

Would you like to receive email promotions for the Luminarium’s teacher-related programming? Yes No

Will the Primary Contact be on site at the Luminarium during the field trip visit? Yes No

Is the billing contact different from the primary contact? Yes No

Step 3 of 5

Guest Information

8. Please indicate how many guests for each grade level will be attending the field trip in the section below.

Please note: Kiewit Luminarium does not provide field trips for Pre-K, Kindergarten, or 1st grade students.

School Staff / Adults

Youth: Grade 2

Youth: Grade 3

Youth: Grade 4

Youth: Grade 5

Youth: Grade 6

Youth: Grade 7

Youth: Grade 8

Youth: Grade 9

Youth: Grade 10

Youth: Grade 11

Youth: Grade 12

9. Will your group have additional parents/chaperones purchasing tickets separately on the day of your visit? Optional

Enter the approximate number. Tickets will be $10 each plus tax.

10. What is the dominant language used by your students and chaperones? Optional

State as many as apply.

Step 4 of 5

Transportation and Additional Information

Mode of Transportation

11. If arriving by school or charter bus, please indicate the number of buses Optional

Select one option. Select it again to clear your answer.

1 2 3 4 5 6 or more

12. If arriving using multiple methods of transportation, please specify Optional

Additional Information

13. Will your group require any additional accessibility accommodations? Yes No

14. Is there anything else we should know about your field trip request? Optional

15. How did you hear about us? Optional

Step 5 of 5

Review Your Information

Review your answers below. Use Edit to return to a section.

Request a Field Trip

Please correct the following

Information About Your Visit

Organization and Contact Information

Organization Information

Contact Information

On-Site Designee

Billing Contact

Guest Information

Transportation and Additional Information

Mode of Transportation

Additional Information

Review Your Information

Request Submitted Successfully

Request a Field Trip

Please correct the following

Information About Your Visit

Organization and Contact Information

Organization Information

Contact Information

On-Site Designee

Billing Contact

Guest Information

Transportation and Additional Information

Mode of Transportation

Additional Information

Review Your Information

Request Submitted Successfully

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