Field Trip Request Form Contact Information Name * First Name Last Name Email * Phone * (###) ### #### Position in School/Organization * School/Organization Information School/Site * Please include school district/organization Address 1 * Address 1 Address 2 City State/Province Zip/Postal Code Country School Phone Number * (###) ### #### Program Selection Program * Plants & Animals (Grades K-2) Nature Innovators (Grades K-2) Wind & Waves (Grades 3-5) Discover the Dunes (Grades 3-5) Energy Explorers (Grades 3-5) Discover the Dunes (Grades 6-8) Energy Explorers (Grades 6-8) Bay Studies (Grades 9-12) Brilliant Bivalves (Grades 9-12) Green Building Design (Grades 9-12) Eco Engineers (Grades 9-12) Grade Level * 1 2 3 4 5 6 7 8 9 10 11 12 K Requested Date - Option 1 * MM DD YYYY Requested Date - Option 2 * MM DD YYYY Lunch on-site? Yes No How many students? * We have a maximum number of classes/ students depending on requested program and date. We may not be able to accommodate your group on your requested date, but will work with you for a suitable time(s). How many classes? * How many Special Education students? Please enter "0" if no Special Education students will be attending. How many ELL students? * Please enter "0" if no ELL students will be attending. Will you be applying for Connect Kids? * Yes No Do you need help completing the Connect Kids application? Only answer if you selected "Yes" to previous question. Yes No Thank you for choosing a field trip at Jones Beach Energy & Nature Center. We look forward to hosting your group.An Environmental Educator will email you within 24 - 48 hours of receiving your form to schedule your program. We use Zoom as our platform for virtual field trips. If you have any questions or technological inquires please contact our education team at jbenc@parks.ny.gov. Connect Kids Program Information
