HSJ: Education: School Registration Form

History San José - School Registration Form

Registration forms received before registration open date and time WILL BE DISCARDED.

Registration for Experience Adobe Days opens on Monday, June 16, 2008 at 8:00 am.

Registration for Westward Ho! opens on Monday, July 14, 2008 at 8:00 am.

Registration for all over programs opens on Monday, July 28, 2008 at 8:00 am.

Please use a separate form for each program or tour requested.

Please list a contact name, address and phone number for each class registering. Registration forms without this information will be placed at the bottom of the list.

* Required fields

Today's Date: August 28, 2008

Program or Tour Requested: (select one) *

	A Child's Life in the 1890's (Grade 2, $6 per student)
	Experience Adobe Days (Grade 4, $10 per student)
	Experience Victorian Days (Grade 3, $9 per student)
	Gold Rush Adventure Kit - 1 week rental (Grade 4, $115)
	Gold Rush Adventure Kit - 2 week rental (Grade 4, $150)
	Historic Transportation Experience (Grade 2, $6 per student)
	History Hike - Unavailable for the 2008/2009 school year.
	History Park Tour (Grades 3 - 12, $5 per student)
	The Immigration Experience (Grade 4, $6 per student)
	People at Work (Grade 3, $6 per student)
	Peralta Adobe & Fallon House Tour - Unavailable for the 2008/2009 school year.
	School Days in the 1890s (Grades 4 - 5, $9 per student)
	Valley of Heart's Delight (Grades 3 - 4, $6 per student)
	Victorian Family Life (Grades 3 - 4 , $150 per visit)
	Westward Ho! (Grade 5, $10 per student)

Preferred Dates and Times of Visit
Please indicate 3 windows of availability (e.g., any weekday Sept. - Dec.) for your program. You may type up to 32 characters in each box. We will do our best to accommodate your requests, as programs are reserved on a first come, first served basis.

	1st preference:
	2nd preference:
	3rd preference:

Group Information

	Name(s) of all Teachers coming: *
	Teacher Phone(s): *
	Teacher Email(s):
	Class Details
	Grade Level:
	Number of Classes:
	Number of Chaperones in each Class:
	Number of Students in each Class:
	School Details
	Name:
	Street Address:
	City:
	Zip Code:
	Phone Number:
	Fax Number:
	Contact Details
	Role: Teacher: Parent:
	Name:
	Daytime Phone Number: (include area code)
	Evening Phone Number: (include area code)
	Email Address:

Tour Information

	Will you visit O'Brien's Candy Store at History Park? Yes: No: (If yes, add 45 minutes per class to your field trip schedule)
	Will you visit the Museum Store at History Park? Yes: No: (If yes, add 45 minutes per class to your field trip schedule)
	How will your class travel to the museum? Auto: School Bus: Mass Transit: Other:
	Do your students have any special needs? Yes: No: If yes, please explain:

Do you receive HSJ's School Program Brochure over the summer? If not, we will be happy to mail it to your home address rather than your school.

	Teacher Name:
	Home Street Address:
	City:
	Zip Code: