Hands on History - School Field Trip Registration Form

Programs Offered Include:

Colonial Life at Rippon Lodge
Civics in the Past and Present at Brentsville Courthouse Historic Centre
19th Century Farming at Ben Lomond Historic Site
and more!

Hands on History:

Connects students to their local history through place-based learning
Includes interactive, hands-on opportunities for students to learn the craft of history firsthand
Fulfills History and Social Science Virginia Standards of Learning
$10 per student

1. School Name *This question is required.

2. Grade Level *This question is required.

3. School Address *This question is required.

4. Requested Date(s) of Field Trip *This question is required.

Requested Date of Field Trip (Please provide any additional requested dates in the comment box below in case first requested date is not available). *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Requested Times *This question is required.

Comments *This question is required.

5. # Students Attending Per Day ($10.00 per student) *This question is required.

6. Normal Lunch Time *This question is required.

7. Emergency Contact at School Name *This question is required.

8. Emergency Contact at School Phone Number *This question is required.

9. Emergency Contact at School E-mail *This question is required. This question requires a valid email address.

10. Lead Teacher Name *This question is required.

11. Lead Teacher Cell Phone *This question is required.

12. Lead Teacher E-mail *This question is required. This question requires a valid email address.

13. Bookkeeper Name *This question is required.

14. Bookkeeper Phone *This question is required.

15. Bookkeeper E-mail *This question is required. This question requires a valid email address.

16. Allergies (please type N/A if none) *This question is required.

17. How many buses? *This question is required.

18. How many cars? *This question is required.

19. How many students per teacher/chaperone? *This question is required.

Not sponsored or endorsed by PWCS. To request reasonable ADA accommodations, please call (703) 792-8066.