![](media/image1.png){width="1.1291666666666667in"
height="1.125in"}Tualatin River National Wildlife Refuge

19255 SW Pacific Hwy, Sherwood, OR 97140

> Phone: 503-625-5944 Fax: 503-625-5947

Contacts: Janice Jenkins or Kim Strassburg

Email: janice_jenkins@fws.gov or <kim_strassburg@fws.gov>

**Application Form for Field Trip Reservation**

**Participating in the Tualatin River National Wildlife Refuge
environmental education program can be an exciting, adventurous and
inspirational experience for your students. It is a chance for children
to make their own special connections to nature and wildlife, and for
educators to help nurture in them a respect and love for our natural
environment. National Wildlife Refuges are special places, and in order
to protect this refuge and to provide students high-quality experiences,
some guidelines are necessary.**

**[What You Need to Know]{.underline}**

1.  This application is not a confirmation of your reservation. You will
    be sent written notification confirming dates and times for your
    group's visit.

2.  Applications are processed on a first-come, first-served basis.
    Applications will be accepted only during the school year of the
    date requested.

3.  Teachers must have participated in the Refuge teacher workshop
    within the past two school years to sign up for a field trip. No
    exceptions. Teacher workshops will be offered twice a year, once in
    fall (typically early- to mid-October) and once in spring (typically
    early- to mid-March).

4.  Field trips to the Refuge rely entirely on an educator-led concept.
    Teachers must prepare and lead their field trips.

5.  Volunteer Refuge Naturalists will be paired with field trips to the
    greatest extent possible. When available, volunteers will welcome
    and orient your group and sometimes accompany your class during
    their entire visit.

6.  Students must have color coded name tags and already be broken down
    into appropriate groups. Break groups down by the following colors:
    blue, green, red, yellow and orange. These color codes will help
    Volunteer Naturalists organize students into their appropriate
    groups when they arrive at the Refuge.

7.  The following application and accompanying field equipment request
    form must be submitted to the Refuge no later than 3 weeks in
    advance of your requested date. Allow 2 weeks for your application
    to be processed. Please mail, fax, or email completed forms to the
    address above. Incomplete applications will be returned.

8.  Become familiar with and follow all field trip guidelines found in
    Refuge Field Trip Preparation Section.

9.  Field trips to the Refuge are to be formally structured and follow
    the activities set forth in the Refuge Curriculum. Adaptations to
    these activities are acceptable within the confines of the field
    trip guidelines.

    **[Field Trip Information]{.underline}**

  --------------------------------------- --------------- ---------------
  Name of School/Group :                  Grade:          Age(s):      

  Total \# in group\*\*:                  \# Adults:      #Students:
                                                               

  Contact Person:                                         

  School Address:                                         

  City:                                   State:          Zip:      

  Email:                                  Phone:          Fax:      

  Cell phone of an adult who will                         
  accompany your field trip (REQUIRED)                    
                                                          
  --------------------------------------- --------------- ---------------

*\*\*Maximum number of students is 70. An adult-to-student ratio of 1:5
is required for 3rd grade and under. An adult-to-student ratio of 1:10
is required for 4th grade and up. Adult supervision is required at all
times.*

**Date/Time/Transportation for Field Trip**

  ------------ --------- -------- -------- ----------------- --------- -----------
  Date:                  Time:             Transportation:             

  1^st^ Choice 2^nd^     Arrive   Depart   \# Buses          \# Cars   \# Vans
               Choice                                                  

                                                                            
  ------------ --------- -------- -------- ----------------- --------- -----------

**[Pre-Trip Activities]{.underline}**

Give a brief description of your pre-trip activities. How will the
students be prepared for this field trip?

     

**[Trip Goals]{.underline}**

Describe your field trip goals.

     

**[Lesson Plans]{.underline}**

Include what your students will learn, and what Lesson Plans from the
Field trip curriculum you will be using. If you are using your own
lessons, give specific details on the lessons.

     

**Group Assignments**:

*Classes are required to break into groups of no more than 15 students.
However, for the best learning experience, we encourage groups of 10 or
less. Please designate groups before arriving on the Refuge. Maximum
number of students is 70. An adult-to-student ratio of 1:5 is required
for 3rd grade and under. An adult-to-student ratio of 1:10 is required
for 4th grade and up. Adult supervision is required at all times.*

  ---------------- ------- --------- --------- --------- --------- ---------
  Group            Red     Yellow    Green     Blue      Orange    Other

  \# of Students                                                        

  \# of Chaperones                                                      
  ---------------- ------- --------- --------- --------- --------- ---------

**Lesson Agenda**:

Record your complete agenda in the table below. Attach an additional
sheet if necessary. Please have chaperones/group leaders prepared to
follow this plan upon arrival. Have each Group's color visible on
student's name tag for quicker organization into their appropriate
groups at the Refuge.

+---------+---------+----------------+--------------------------------+
| **Time  | **Group | **Lesson       | **Lesson Name/ Activity**      |
| Slot**  | Color** | Site**         |                                |
|         |         |                |                                |
|         |         | **(**Select    |                                |
|         |         | one from       |                                |
|         |         | list**)**      |                                |
+---------+---------+----------------+--------------------------------+
|         | Red     |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Yellow  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Green   |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Blue    |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Orange  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Other   |                |                                |
+---------+---------+----------------+--------------------------------+
| **Time  | **Group | **Lesson       | **Lesson Name/ Activity**      |
| Slot**  | Color** | Site**         |                                |
|         |         |                |                                |
|         |         | **(**Select    |                                |
|         |         | one from       |                                |
|         |         | list**)**      |                                |
+---------+---------+----------------+--------------------------------+
|         | Red     |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Yellow  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Green   |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Blue    |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Orange  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Other   |                |                                |
+---------+---------+----------------+--------------------------------+
| **Time  | **Group | **Lesson       | **Lesson Name/ Activity**      |
| Slot**  | Color** | Site**         |                                |
|         |         |                |                                |
|         |         | **(**Select    |                                |
|         |         | one from       |                                |
|         |         | list**)**      |                                |
+---------+---------+----------------+--------------------------------+
|         | Red     |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Yellow  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Green   |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Blue    |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Orange  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Other   |                |                                |
+---------+---------+----------------+--------------------------------+
| **Time  | **Group | **Lesson       | **Lesson Name/ Activity**      |
| Slot**  | Color** | Site**         |                                |
|         |         |                |                                |
|         |         | **(**Select    |                                |
|         |         | one from       |                                |
|         |         | list**)**      |                                |
+---------+---------+----------------+--------------------------------+
|         | Red     |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Yellow  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Green   |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Blue    |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Orange  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Other   |                |                                |
+---------+---------+----------------+--------------------------------+
| **Time  | **Group | **Lesson       | **Lesson Name/ Activity**      |
| Slot**  | Color** | Site**         |                                |
|         |         |                |                                |
|         |         | **(**Select    |                                |
|         |         | one from       |                                |
|         |         | list**)**      |                                |
+---------+---------+----------------+--------------------------------+
|         | Red     |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Yellow  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Green   |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Blue    |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Orange  |                |                                |
+---------+---------+----------------+--------------------------------+
|         | Other   |                |                                |
+---------+---------+----------------+--------------------------------+

**Volunteer Naturalist Needed?** Y N

Wetland Pond Study (required)

Water Testing Study

**[Other Special Needs or Concerns]{.underline}**:

     

**Thank you for your close attention to planning your field trip.
Planning ahead will make your visit the best it can be. We look forward
to seeing the expression of excitement and discovery on your students'
faces. Enjoy your visit!**