Registration for Student Tours
UCM Museum

22275 Hwy 36
Abita Springs, Louisiana 70420
(985) 892-2624

Ann O'Brien, home-office (985) 892-8097

School/Group________________________________ Phone (___)_________

Address ________________________________________________________

City ______________________________ State ______ Zip ______________

Name of contact person(s) __________________________________________

Email_______________________ Phone (___)_________________________

Best time(s)______________________________________________________

Circle all that apply: Public   Private/Parochial   Other __________________

Regular   Special Needs   Talented   Gifted   Visual Arts

Grade Level(s) K 1 2 3 4 5 6 7 8 9 10 11 12

Number of classes _____, # per class _____, total students possible_______

Total number of teachers and adult chaperones you expect to have _______

Names of Teachers _____________________________________________

______________________________________________________________

 

_____ Basic Tour, $1.50 per student, minimum charge $24 for first 16 students. Maximum 45 students in one time slot.

_____ Hands On Tour, Recycled Art, $3.50 per student, minimum charge $56. Maximum 60 students divided into 2 groups.

Special needs: ________________________________________________

Date(s) requested _____________________________________________

____________________________________________________________

Estimated time of arrival ___________________

E-MAIL for field trip information