Document 69145

For Museum Use Only
Assigned by:_______ Field Trip Date: ____________ Time:____________ Lunch Room Assigned: ____________ Lunch Room Time(s):_______________
Confirmation Packet Sent On:___________ Information Provided to Louise’s :________ Entered into Master Calendar :_________
Museum Mania Field Trip Request Form
A group consists of 15 or more and is limited to groups no larger than 55 people. Rates depend on group activities and lunch. “Museum Mania” is
held on Tuesdays and Wednesdays from 10AM- 2PM. Day begins at The Terre Haute Children’s Museum and concludes at The Clabber Girl
Museum. To request a reservation, return form to Abby Koester or Megan Marvin (contact information on back of sheet). Once a request has
been made, we will call the contact person listed within 3 business days. A complete field trip packet will be mailed after we have called you back.
Your visit is not confirmed until you receive a confirmation packet. Groups or classes that require separate receipts must make separate
reservations. Field Trip reservations are made based on space and availability.
Contact Name: _______________________________________________________________________________________________________
Name of School/Organization: _________________________________________________________________________________________
Address: ______________________________________________________________________________________________________
Daytime Phone: _______________________________________________ Alternate Phone: _______________________________________
Fax Number: __________________________________________________ Email: _________________________________________________
Preferred Method of Contact:
Best Time to Call ______________________________________________________
Ages of Students Visiting_________________________ Grade of Students Visiting ____________________________________________
# In Your Group:
# of Students__________ # of Teachers__________ # of Chaperones__________
Special Needs (Please specify):___________________________________________________________________________________________
Typical Schedule
10AM: Groups will arrive at the Terre Haute Children’s Museum and have a short orientation before beginning their self-guided visit at the
Children’s Museum.
12PM: Groups will eat lunch at preferred location. (Options are below.) Depending on location, groups will walk to Clabber Girl Museum after or
before lunch.
1PM: Groups will tour the Clabber Girl Museum and participate in an activity in Clabber Girl’s Kitchen.
2PM: Groups will depart from Clabber Girl Museum. Departure location is determined by weather and bus parking.
Date of Visit
Museum Mania field trips can be held Tuesdays or Wednesdays beginning at 10 AM at the Terre Haute Children’s Museum and end approximately
at 2 PM at the Clabber Girl Museum. Assignments are made based on availability. We will do our best to schedule your field trip on your
preferred date. Times are Eastern Standard Time
Top 3 Date Choices: 1)________________ 2) ________________ 3)________________
Lunch Options
There are several lunch options for your students, please check one:
We would like to bring sack lunches and reserve a party room at the Terre Haute Children’s Museum for our group to eat. (+ $1 per
We would like to order lunch from Louise’s Café and eat at the Terre Haute Children’s Museum (870-4612) (+ $4 per person): You are
responsible to pay for all of the lunches you have ordered.
We would like to order lunch from Clabber Girl and eat at the Clabber Girl Museum (812-478-7119) (+ $4 per person): You are
responsible to pay for all of the lunches you have ordered.
We will not eat lunch at either museum (no additional charge)
Terre Haute Children’s Museum Field Trip Reservation Policies
Please review the policies and guidelines below. Initial each one and sign below. Request forms that have not been initialed and
signed will not be scheduled.
___ There is a required 5:1 adult to child ratio when visiting both museums.
___ A group visit must consist of at least 15 people to receive a group rate.
___ The Terre Haute Children’s Museum will not accept memberships, admission tickets or discounts during field trips.
___ Payment must be received in a SINGLE check, credit card or cash transaction for each museum. Guest count must be finalized three business
days prior to your visit. Any additional guests will be charged the general admission fee of $7.
___ The Terre Haute Children’s Museum and The Clabber Girl Museum cannot offer refunds or balance due adjustments for absent children.
___ Chaperones must stay with their assigned children and are responsible for their children’s behavior.
___ Lunch times and locations are non-negotiable.
___ Cancellations must be made three business days prior to the day of your trip. If you do not notify us of your cancellation, a $25 cancellation
fee will be charged to your school.
___ Bus drivers are required to drop children off at the field trip entrance and are encouraged to park on 8th St. Children cannot be dropped off
anywhere else due to safety procedures.
___ If your group does not abide by our field trip policies, a phone call will also be made to their administrator and they may be asked to leave the
Payment Method
Please pay for your field trip immediately following your group orientation. Payments must be made separate to each museum via check,
Visa/MC/Discover or cash transaction. We cannot offer refunds or balance due adjustments for absent children for admission or
*Due to Terre Haute Children’s Museum
*Due to Clabber Girl Museum
*Free Chaperones (1 for every 5 children)
Lunch Options (please choose one):
 Lunch in another location
- Sack Lunch in Children’s Museum (ALL chaperones and
 Lunch from Clabber Girl (Total lunches ordered)
 Lunch from Louise’s (Total lunches ordered)
*Additional Chaperones will be charged $5 each
@ $5 per person
@ $6 per person
@ $1 per person
@ $4 per lunch
@ $4 per lunch
Total Due=
I have read and understand all policies and procedures: * Signed Name____________________________________ Date ____________
To request a visit, return this form to Abby Koester at:
E-mail: [email protected]
Fax: 812.238.1680  Phone: 812.235.5548
Address: 727 Wabash Ave. Terre Haute, IN 47807
Megan Marvin at:
E-Mail: [email protected]
Fax: 812.478.7181 • Phone:812.478.7119
Address: 900 Wabash Ave. Terre Haute, IN 47807
Once we receive this form, a representative from either museum will contact you to confirm your field trip date/time and to discuss additional