Field Trip Application

Print the following form, fill in your information, and fax it to: 312 / 284-5575

We will then contact you to confirm your field trip.

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Organization/Group name:

Contact Person:

Contact Person Phone #:

Contact Person E-mail:

Contact Person Address:

Number of children in group(min: 5/max: 25):

Age of children in group(min: 3 yrs. old/max: 10 yrs.old):

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Choose Field Trip Theme and Fee:

_____Fun With Flowers! ($3.00/per child)
_____Grow Your Favorite Veggies! ($3.00/per child)
_____Pick A Pot & Plant It! ($20.00/per child)
_____Pick A Pumpkin! ($3.00/per child)

x ______ children = $__________________ (total cost)

Please make checks payable to: Clover’s Garden Center.
Note: Adult chaperones are required to stay with the group and are always free!

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Contact’s Signature:

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Note: You may choose any field trip date & any field trip location.

Select Day of Field Trip (check one): ____ Monday ____ Tuesday ____ Wednesday ____ Thursday Select Date of Field Trip:

Select Time of Field Trip (check one): ____ 10:00 - 11:00 a.m. ____ 10:30 - 11:30 a.m. ____ 1:00 - 2:00 p.m. ____ 1:30 - 2:30 p.m. ____ 4:00 - 5:00 p.m. ____ 4:30 - 5:30 p.m. ____ 5:00 - 6:00 p.m. ____ 5:30 - 6:30 p.m. ____ 6:00 - 7:00 p.m. ____ 6:30 - 7:30 p.m.

Select Location of Field Trip (check one): __Berwyn __Elmhurst __Hickory Hills __Hometown __Mount Prospect __Naperville (on Chicago Ave.) __Niles

__Norridge __Oak Forest __Skokie __St. Charles __Westmont __Willowbrook __other (please list)

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Office use only:
date rec’d:                    date confirmed:                   confirmed by:                    confirmed with:                   guide assigned: