Field Trip Request Form

Teacher Name(Required)

First Last

School District(Required)

School Name(Required)

School Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

OERB Curriculum Taught:(Required)

Little Bits

Fossils to Fuel

Fossils to Fuel 2

Petro Active

Rockin' Ratios

CORE Energy Language Arts

CORE Energy Math

CORE Energy Science

CORE Energy Social Studies

Select all that apply.

1. Have you completed the OERB curriculum in your classroom this year?(Required)

Yes

Partially completed

Field Trip Information

Museum You Plan to Visit(Required)

Ticket Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

IMPORTANT: Tickets will be mailed to this address. Please ensure it is a valid mailing address.

Teachers Phone Number(Required)

IMPORTANT: If there is a question about your tickets, the Blue may contact you at this phone number and/or your email address.

Student Grade Level(s)(Required)

Select all that apply.

# of Classes Attending in which you are the primary teacher(Required)

This should include ONLY the # of classes you taught the curriculum to and that will be attending the Field Trip.

Total # of Chaperones(Required)

The OERB will cover the cost of 1 chaperone per 5 students plus 1 ticket for the OERB trained teacher (yourself). IMPORTANT: Include your 1 ticket in your chaperone count.

Total # of Students in your class(es)(Required)

OERB Waiver of Liability

Please read carefully and sign.

School and school district indemnify OERB for the following:
-Any and all injuries/deaths incurred during transportation to and from OERB-sponsored trips/events.
-Any and all injuries/deaths incurred during OERB-sponsored trips/events.

The teacher should review acceptable standards of conduct with the students in advance of the trip. The teacher has primary responsibility of the conduct of the students. If students steal, deface property or behave in an inappropriate manner during OERB-sponsored trips/events, OERB retains the right to exclude school/school district from future participation in OERB-sponsored trips/events.

Please indicate that you agree and acknowledge this waiver by typing your name and date below.

Teacher Name(Required)

Full Name

Date(Required)

Important Field Trip Information

Teachers must complete teaching the OERB curriculum before turning in the Field Trip Request form.

Your field trip will only be approved for the closest, age-appropriate museum. If you are not planning to attend that museum, you must have pre-approval from the OERB before submitting this form.

Once your field trip is approved, you will receive an approval email from Teachers@oerb.com. Please allow 2 weeks for processing. If you haven't received an approval email after two weeks of submission, please email Teachers@oerb.com.

**We are asking each OERB funded field trip to take a picture with a branded sign provided by the museum. Please make sure your students have a signed photo release form on file with you and/or your school. You can upload your photo directly on HomeRoom using the Field Trip Photo Submission Form. We would love to share how much fun you're having on your OERB sponsored field trip!**

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