Norton Simon Museum

Staff-Guided Tour Request Form

Name of School

Contact Person

Phone Number (school/home/or cell)

Fax Number

Email Address

Street Address (school or home)

City, State, Zip

Student Grade Level

Subject

Total Number of Students

Total Number of Chaperons

Chaperone: Student Ratio

Under 6th grade	1 adult for every 5 students
6th - 9th grade	1 adult for every 8 students
10th - 12th grade	1 adult for every 10 students

List three possible dates and times in order of preference.
Please note that the Museum is CLOSED on Tuesdays.
Please remember tours are 75 minutes long!

Requested Date 1

Requested Start Time 1

9:30
10:00
10:30
11:00

Requested Date 2

Requested Start Time 2

9:30
10:00
10:30
11:00

Requested Date 3

Requested Start Time 3

9:30
10:00
10:30
11:00

Do you wish to re-enter the Museum after the tour at 12:00 p.m.?

Yes
No

Will you be arriving by bus?

Yes
No

Special Notes