Field Trip Registration | Coweta STEM Institute

School Name

Teacher/Contact Person:

First

Last

E-mail:

Phone:

Area Code

Phone Number

Address:

Street AddressCityState / Province / RegionPostal / Zip CodeCountry

Word Verification:

Title of Field Trip

Date Preferred (IF available):

Grade Level:

Number of Classes:

Number of Students:

Number of Teachers (minimum of one per class):

Number of other adults (max of two per class):

Payment Options:

$6.00 per student (CCSS)

$7.00 per student (CCSS Planetarium)

$9.00 per student (non-CCSS)

$11.00 per student (non-CCSS Planetarium)