Date and Time __________________________________________________

Contact Person____________________________________________

Name and address of school ________________________________________________

_______________________________________________________________________

E-Mail _______________________________________________________

Phone______________________________Fax#__________________________

Choice of Field Trip check one:

A. Open Field Trip____________

B. Focus field trip_____________

C. Create Your Own___________

Number of children in group ($5 each) _______________ Age of children___________

Number of adults_________ Number of Additional adults @ $5 each_______________

(1 for every 5 children)

Would your group like to visit the museum store______________________________

Special needs, please be specific____________________________________________

Deposit for $____________________________Date Pd________

Balance for $_____________________________Date Pd________

Make checks payable to: Community Children's Museum

Mail to: 77 East Blackwell Street , Dover , NJ 07801

For additional information please call Jody Marcus at 973-366-9060 or visit

www.communitychildrensmuseum.org