Group Reservation Request Form

Please note:  This form does not constitute a reservation.  This is a request only as field trips are based upon availability.  A representative from the Children's Museum will contact you within 72 hours and will make every effort to accommodate your first choice.

* required fields

SCHOOL/ORGANIZATION INFORMATION

School/Organization:*

Mailing Address:*

City:*

State, Zip:*

 ,

Daytime Phone:*

CONTACT INFORMATION

First Name:*

Last Name:*

Title:

Mailing Address:


(if different from above)

City:

State, Zip:

,

Phone:


(if different from above)

Email:*

FIELD TRIP INFORMATION

Type of Field Trip:*

Teacher's Choice

 

Guided Field Trip

 

Focus Field Trip
(please indicate type of focus trip )

Visitor Information:

Number of Children:*

(at least 15 for group rates)

Age Range:*

from to

Number of Chaperones:*


(we require one chaperone for every five students)

Date of Field Trip:

1st Choice:*

Date:

Pick Date
(format: mm/dd/yr)

Arrival Time:

Departure Time:

2nd Choice:*

Date:

Pick Date
(format: mm/dd/yr)

Arrival Time:

Departure Time:

3rd Choice:

Date:

Pick Date
(format: mm/dd/yr)

Arrival Time:

Departure Time:

Would you like 30 minutes scheduled in our lunch room for brown bag lunches?

Yes, select time:

Would you like to purchase a pre-made box lunch for each student? 
If yes select choice:

Sandwich Choice

Quantity

Turkey & Cheese

Peanut Butter & Jelly

Cheese

Hot Dog

($4.50 per lunch box + tax, 7%. minimum total of 15 with a minimum per choice of 5)


Includes one sandwich, chips, applesauce and a ½ pint milk. Whole fruit can be substituted for applesauce upon request. Box Lunch orders must be placed at least 5 days in advance. For questions concerning allergies or recipes contact the Café manager at 412-322-5058 ext 203. Adult and chaperones can also place orders from the Café menu

Would you like to purchase a pre-made box lunch for the parents/chaperones? 
If yes select choice:

Basic Sandwich Box Lunch Meals
$6.50 each plus tax, minimum of 5 total order
All sandwiches are served on a Kaiser roll with lettuce, tomato and pickle spear.
Condiment packets, napkins and wrapped utensils are also included.

Sandwich Choice

Quantity

The Attic
Smoked Sliced Turkey & American Cheese, Baked potato chips, bottled drink

The Studio
Chicken Salad, Baked potato chips, bottled drink

Waterplay
Tuna Salad, Baked potato chips, bottled drink

The Nursery
Isaly’s Chipped Ham & Swiss Cheese, baked potato chips, bottled drink

The Workshop
Roast Beef & provolone cheese, baked potato chips, bottled drink

The Backyard  - $5.50 each plus tax
Garden Salad, baked potato chips, bottled drink

Add a chocolate chip cookie to above boxes for $1.00 each: Yes

The Theatre - $25.00 plus tax
One 10 Cut Cheese Pizza,  6 Bottle Drinks, 6 bags of baked potato chips
Add pepperoni for $2.00: Yes

 

Special Needs/Accomodations:

 

Comments:
 

 
        

©2004 Children's Museum of Pittsburgh - 10 Children’s Way - Allegheny Square - Pittsburgh, PA 15212
Phone: 412.322.5058 - Fax: 412.322.4932 - Email: stuffee@pittsburghkids.org