FIELD TRIP RESERVATION FORM The DuSable Museum of African American History welcomes groups of all ages.

Reservations are required for all groups larger than 10 people or small groups requesting educational programming. Please make your reservation for guided tour, self guided tour, treasure hunt, education class, or matinee at least 3 weeks prior to your visit. Please note: chaperones and teachers are responsible for supervising groups. Student groups (K-12) must have one adult chaperone per every 10 students. All educational programs and tours are set to begin at 10:30am. Please review the attached Field Trip Policies sheet before visiting to ensure an enjoyable experience. ***Return page 1 by email to egriffin@dusablemuseum.org or fax 773.947.0677***

CONTACT INFORMATION Name of School/Group/Address Lead Contacts Name Lead Contacts Email Lead Contacts Phone # of Students Field Trip Date and Time Field Trip Date Field Trip Time # of Chaperones

Grade(s)

Check all that apply: ( ) ESL ( ) Special Needs

( )Wheelchair Access ( )Other

MUSEUM EXPERIENCE: PLEASE CHECK ALL THAT APPLY CPS Schools, Illinois Public Schools, and Park District Groups are given free admission Experience Check Total Cost Guided Tour FREE (CPS, IPS, & Park District) Self Guided Tour Treasure Hunt Matinee Educational Program (Please select from the list below) FREE(CPS, IPS, & Park District) FREE(CPS, IPS, & Park District) $7 per person including Chaperones $7 per student

Educational Programs DuSable Mobile Museum Diggin up the Dirt on Ancient Egypt: Uncovering the Myths Exploring Ghana From Africa to Capture to Freedom: The Underground Railroad Experience Lady Moses: Life and Times of Harriet Tubman In the Future Weve Yet to See, What Will Your Legacy Be? Making History Come Alive Learning Leadership: Lessons from Harold Washington Red, White, Blue, and Black Roots in the Real World Story Time at the DuSable The Legend of Jean Baptiste Pointe DuSable Whats in the Water When Good Broccoli Goes Bad-The Musical Summer Program (List Program Name)

Check your selection

FIELD TRIP POLICIES Registration View information on Field Trips, Matinees, Programs, and related events at http://www.dusablemuseum.org/education/programs Pre-registration is required for all teachers, chaperones, and students at least 3 weeks in advance of visit. Field trips and student programs are only available for groups of 10 or more. Registration for groups is required on Museum Free Days. Chaperones Pre K groups must be accompanied by a minimum of 1 adult for every 5 students th K through 12 grade students must be accompanied by 1 adult for every 10 students Adults in excess of the ratio not included in pre-registration will be subject to full admission costs upon arrival Students must remain with their chaperones at all times. Failure to adequately supervise your group may result in the group being asked to leave the Museum Conduct Back packs or large purses are not allowed into the Museum galleries Photography is not permitted inside of the Museum galleries Horseplay and/or roughhousing are not permitted inside of the Museum galleries Payment To cancel or revise your reservation email egriffin@dusablemuseum.org Cancellations or changes to reservation must be made 14 days prior to scheduled visit to receive a refund. Incidentals The DuSable does not have a lunch room facility and cannot store lunches at this time Large backpacks and purses are not allowed inside of the galleries Food and drink are not allowed inside of the galleries Photography is not allowed inside of the galleries

740 E. 56th Place Chicago, IL 60637 773.947.0600 phone 773.947.0716 fax www.dusablemuseum.org

DuSable Bust Sculpture: Erik Blome