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School Visit Lesson Request Form

To request a lesson, fill out all required fields ( indicates a required field).

 
Primary Contact Person
Name:
Title:
Phone:
E-mail:
School/Institution
Name:
Street:
City:
State:
Zip:
Schedule my class to eat in the student lunchroom.
Please send me a copy of the orientation DVD, "Look, Learn, Discover: School Group Visits at the Philadelphia Museum of Art"
Class & Lesson Information
Lesson:
# Students:
Grade Level:
Class Subject:
  Tell us about your class!
How will this lesson relate to your curriculum? Any information you provide will help us to relate this lesson more directly to your studies. Are any special accommodations required?

Lesson Date and Time
Requests are booked in the order that they are received. We can not guaranty that the date and time you are requesting is available. Please supply a second choice and our staff will contact you regarding the availability or other possible time options.

Please note school lessons are offered Tuesday – Friday only.
1st Choice:
Date:
Start:
2nd Choice:
Date:
Start:

Code: Please enter the following code into the text field in order to validate this message.(case sensitive)
 

If you would like to submit multiple lesson requests, use the "Submit & Duplicate" button to pre-populate your next request.