West Field Trip - Educational First Steps

Name of Center(required)

Address(required)

City, State, and Zip Code(required)

Phone Number of Center(required)

Name of Adult in Charge the day of field trip(required)

Email address(required)

Cell phone # of adult in charge the day of field trip(required)

Date you would like to attend the Field Trip (1st option)(required)

Date (2nd Option)(required)

Date (3rd Option)(required)

Is this an outreach program at your center? (required)

If this is an outreach program I will contact you to get the name of the program your center will participate in.

Location you would like to visit?(required)

Arrival time to field trip(required)

Departure time from field trip(required)

# of Children (ages 4 & 5 only)(required)

# of Adults (EFS will only pay for 1 adult for every 10 children)(required)

Will your center need transportation? (Transportation is only provided to center's who do not have transportation)(required)

Please see Policy and Procedure's for field trips above.

Electronic Signature to make reservation for field trip(required)

Type the characters(required)