Submitted Date Submitted Date: Date Submitted Date: Time School Information School Name Street Address City State Zip Code School District We are a Title I School with 30% or more of our students receiving free or reduced lunch. Please send me additional information about how to apply for transportation reimbursement for up to $500 per bus and return tickets for students. Teacher Information Teacher Name Email Address Email Address Confirm email Primary Telephone Number Day of Visit Telephone Number Group Information Number of Students (Ages 4-18) Maximum of 220 students per request form. Number of Adults (19+) For every 5 students attending, groups will receive 1 free adult admission (ages 19+) Number of Additional Adults (19+) Additional Adults (19+): $21 Number of Personal Care Attendants, 1:1 student aides or nurses Grade(s) List any student accommodations we can provide for your group. Visit Information For current self-guided field trip availability Group Visits: 610-388-5223 First Date Preference Second Date Preference Third Date Preference Are you requesting more than one field trip? Please check if you have more than 220 students and are completing more than one field trip request form. Arrival Time 10:00-10:30 AM 10:30-11:00 AM 11:00-11:30 AM 11:30 AM-12:00 PM 12:00-12:30 PM 12:30-1:00 PM Departure Time Please enter the time your group will depart Longwood Gardens. Number of Busses Dining Options (choose one) The group will purchase food in the Café; seating available on a first come, first serve basis. The group will not be eating lunch in the Gardens. Additional Information Agreement I understand that a minimum of 15 students must be in attendance on the day of our visit to qualify for free field trip & admission. I will provide a final count of students, adults, and student support staff, 1:1 aides and/or school nurses to Longwood Gardens three weeks prior to my scheduled visit. I agree to act as lead teacher for this visit, responsible for all communication with Longwood Gardens and adults attending the trip. I understand that Longwood Gardens requires 1 adult for every 5 students provided in the final count. Additional adult admissions are not free and must be paid for prior to arrival to the Gardens. I understand that cancellation of my program less than three weeks prior to my visit date may affect my school’s ability to receive free programs or visits in the future. I will provide feedback by completing the online survey after my visit.