The Bakken Field Trip Registration Form

Field Trips at The Bakken - Where Students Get Charged Up About Science

Field Trip Registration Form

	Please fill out a separate registration form for each separate DAY you plan to have groups come. For example, if you want to bring 4 groups over two days, please fill out two separate registration forms, one for each day.
	The Bakken can accommodate up to 4 groups of 16-32 students per day.
	Do not use the Enter key on your keyboard until you are finished filling in the form. Instead, use your mouse or the Tab key to move down the page.
	Tips for a successful Field Trip at The Bakken.

Please Fill in Your Name and Contact Information:

Teacher's Name
(main contact)

Full School Name

School District Name

School Address

City

State

Zip

School Phone

Ext or VoiceMail

Fax

E-Mail

Summer Contact Information

Preferred method of contact

Best Time to Call

Group Information

Total Students

Group Count
(16-32 Students Per Group)

Grade(s)

Registering for multiple days (for example, six groups over three days)?

If yes, for how many days are you registering?

Other teachers attending

Scholarships available for schools with 40% or more students who qualify for free and reduced lunch.

Check here to apply for a scholarship

% students on free or reduced lunch

If you chose Special Circumstances above please explain

Notes/Special Needs

Field Trip Choices

Scheduling on the SAME DAY

First unit choice

AND

Second unit choice

Check here to order The Bakken's Sparks and Shocks DVD on static electricity for $9.99 (includes S&H)

If ordering The Bakken's Sparks and Shocks DVD, please enter your Tax exempt number for school or district below

Field Trip Date / Time

Month Preference

First Choice

Second Choice

Third Choice:

Day Preference

First Choice

Second Choice

Third Choice

Time Preference

First Choice

Second Choice

If there are particular dates or weeks you would like, list in order of preference

Notes

Confirmation Information

	Confirmation letters with your dates and workshop options will be e-mailed to you directly. Please print a copy of the confirmation letter for your records. If you do not receive an e-mail confirmation letter by September 26th, please call 612-926-3878 ext. 200.
	Registrations for September and October will be scheduled in the order they are received.
	Registrations for November through June will be scheduled starting September 20th, with all registrations received before that date given equal priority. After September 20th, registrations will be scheduled in the order they are received.

The Bakken
A Library and Museum of Electricity in Life

3537 Zenith Avenue South
Minneapolis, MN 55416-4623, USA

Join our E-Mail List
Contact Us
Tele: 612-926-3878 Fax: 612-927-7265

Museum Hours: Tuesday - Saturday 10 to 5
Thursdays 10 am to 8pm
Closed Major Holidays
Library Hours: Monday - Friday 9 to 4:30

Admission: $7 Adults; $5 Students & Seniors; Children 3 and under are FREE!

© The Bakken Updated: August 22, 2008