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Oklahoma Energy Resources Board (OERB) Field Trip

2. Name of School or Youth Group*

3. Office Number of School or Youth Group*

5. Mailing Address*

6. City*

7. State*

8. Zip Code*

10. Your Name*

11. Your Email*

12. Your Phone Number*

14. Preferred Date and Arrival Time of Visit*
    Preferred Date and Arrival Time of Visit Start Date

    Preferred Date and Arrival Time of Visit Start Time

    —

    Preferred Date and Arrival Time of Visit End Date

    Preferred Date and Arrival Time of Visit End Time

16. Second Choice Date of Visit
    Second Choice Date of Visit Start Date

    Second Choice Date of Visit Start Time

    —

    Second Choice Date of Visit End Date

    Second Choice Date of Visit End Time

20. Expected Number of Students (Total)*

21. Grade Level(s)- Select all that apply.*

    1. K
    2. 1st
    3. 2nd
    4. 3rd

    1. 4th
    2. 5th
    3. 6th

    1. 7th
    2. 8th
    3. 9th

    1. 10th
    2. 11th
    3. 12th
23. Number of Students K-2nd

    1 chaperone required for 5 students

24. Number of Students 3rd-12th

    1 chaperone required for 10 students

26. Will you have more chaperones than the number required?*

    1. Yes
    2. No

27. How many additional chaperones will be attending?

    Additional chaperones (including family members, extra teachers, bus drivers, etc.) must pay for their own admission at the ticketing window in person to receive the group rate of $10 plus tax.

31. Have you requested a field trip to the Oklahoma Aquarium through OERB?*

    1. Yes, and I am awaiting approval.
    2. Yes, and they have approved me already.
    3. No.

33. Will you be attending with other OERB-certified teachers?*

    1. Yes
    2. No

34. Accompanying Teachers

    Please list any OERB-certified teachers that will be accompanying your school during the trip.

36. Notes

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field