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2. 4th Grade Building Naperville - Field Trip Request Form

   Naper Settlement offers the 4th Grade  Building Naperville (formerly Living History) program at Naper Settlement in November and early December. Visit dates will be assigned and confirmation sent shortly to all schools.

   The fee is $8 per student; Four Adults Per Class, including the teacher are requested.  There is no charge for these adults.  No additional adults are needed unless required to provide 1:1 student support. 

6. Onsite Field Trip Scheduling Conflicts - Please do not list specific dates you prefer to be scheduled.

   Please list any known November scheduling date conflicts.  District 204 late arrival Wednesdays and other closed dates listed on the District 204 calendar have been noted.

10. School/Organization Information
12. School/Organization Name*
    Please provide full name of school, i.e. Lincoln Elementary vs Lincoln
14. State*
15. Zip*
17. School/Organization Phone #: *
18. School District - Select Applicable District*
    -- Select One --Indian Prairie School District 204Naperville Community Unit School District 203Private School
22. Field Trip Requestor Contact Information
24. Contact/Teacher Name Completing Form *
25. Contact is the*

    1. Teacher
    2. School Admin Staff
    3. Parent/Volunteer
27. Contact/Teacher Phone #:*
28. #EXT
29. Contact/Teacher Email *
33. Student Information

    How many classes and students do you want to schedule for a field trip?

35. Grade(s) of Students
36. Estimated Total # of Students
37. Total # of Classes
41. Classroom Teacher Information

    Provide  teacher name and email for each 4th grade classroom to attend the program.

43. First Name
44. Last Name
45. Email Address
47. First Name
48. Last Name
49. Email Address
51. First Name
52. Last Name
53. Email Address
55. First Name
56. Last Name
57. Email Address
59. First Name
60. Last Name
61. Email Address
63. First Name
64. Last Name
65. Email Address
69. Special Accommodations
    Information about special needs within your classes will allow us to provide the best visit experience possible.
71. Our Classes Have The Following Special Needs

    1. Hearing Impairment
    2. Vision Impairment
    3. ADD/ADHD
    4. Autism
    5. Mobility Limitations

    1. Cognitive Learning Delay
    2. Social Emotional Needs
    3. No Special Needs
    4. Other
73. Number of Required State Aides
    -- Select One --012345678910Other (Indicate below in Special Needs Notes)

    1:1 aides are free with advance notice. They are not considered chaperones.

74. Guests With Wheelchairs
    Please tell us if your classes include guests with wheelchairs, how many and the Classroom Teacher Name(s).
76. Please Tell Us More About Special Needs

    Please provide additional information about any special needs you noted above. This will allow us to fully coordinate your visit and share pertinent onsite pre-visit information.

78. Do You Have Any Additional Questions For Naper Settlement?

    Please share any questions you have about the 4th Grade Living History field trip (Onsite or Virtual).

Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit

* indicates a required field