Name *

First Name

Last Name

Phone *

(###)

###

####

I am interested in my field trip group receiving an activity/coloring packet. *

Yes

No

I am interested in my field trip group having access to the large corn maze during the field trip. I understand that this will add an additional $4 for every field trip child and $6 per every additional chaperone since each chaperone MUST be present when my field trip group goes through this corn maze. I understand that this corn maze is 5 acres and may take my group 30 minutes - 1 hour to complete. *

Yes

No

I am interested in purchasing a student drink package for my field trip group from Rustic Cup Mobile Cafe. I understand that my field trip MUST be scheduled after 10:00 am for this package to be purchased unless my group is larger than 50 people. I understand that tax is included in the prices given below, however tips are greatly appreciated. I understand that each child will have the option to choose between hot cocoa or apple cider and no other drinks apply to this package. *

Yes, and I have more than 150 students attending The Patch and agree to $2 per child.

Yes, and I have more than 80 students attending The Patch and agree to $2.50 per child.

Yes, and I have less than 80 students attending The Patch and agree to $3 per child.

No, I am not interested in this for my field trip group.

I am interested in purchasing a chaperone drink package for my field trip group from Rustic Cup Mobile Cafe. I understand that my field trip MUST be scheduled after 10:00 am for this package to be purchased unless my group is larger than 50 people. I understand that tax is included in the prices given below, however tips are greatly appreciated. I understand that each chaperone will have the option to choose between an americano, latte, mocha, hot cocoa, cider, chai tea, hot/iced tea, and an italian soda and no other drinks apply to this package. *

Yes, and I agree to $4 per chaperone for a 12 oz drink.

No, I am not interested in this for my field trip group.

Is your group planning on eating lunch at The Patch? *

Yes

No

If your group is planning on eating lunch at The Patch, I understand that I am responsible for my field trip groups lunches. I understand The Patch does not guarantee any food vendors will be open during the weekdays. *

Yes

We will not be eating lunch at The Patch

What method of payment would your group like to use? *

Cash

Check

Card

I understand that if I selected card as my method of payment that there will be a $20 processing fee for my field trip group. *

Yes

I did not select card as my payment type

I understand that I can ONLY book appointments for field trips Tuesdays-Fridays, and The Patch is only open for field trips October 1st-31st. *

Yes

No

I understand that due to the high demand of field trips, my appointment time is not reserved until someone from The Patch has contacted me and confirmed my appointment time. *

Yes

No

What day is your group hoping to come out? *

Please remember that this date is NOT guaranteed until you have heard back from someone at The Patch.

MM

DD

YYYY

What time is your group planning on being at The Patch? *

Again, please remember until you have heard back from someone at The Patch that this time is NOT guaranteed.

Hour

Minute

Second

AM PM

I agree to all the conditions listed on this form and at the top of the page and understand my field trip is not considered "booked" until someone from The Patch has contacted me and confirmed my field trip time. *

Yes

No