Restaurant Field Trip Request Form For Middle and High Schools Only

Today's Date

School Name

Grade(s)

Contact Person - First Name   Last Name

Title

School Street Address

City   State - Select - Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont  Zip

School Phone  Home Phone

Email

Number of Students (25-35 please)

Margaritas Restaurant Location - Select - Connecticut - East Hartford Connecticut - Mystic Maine - Lewiston/Auburn Maine - Orono Maine - Portland Brown Street Maine - Augusta Maine - Portland St John Street Massachusetts - Revere Massachusetts - Waltham Massachusetts - Weymouth New Hampshire - Exeter New Hampshire - Lebanon New Hampshire - Portsmouth New Hampshire - Salem New Hampshire - Manchester New Hampshire - Nashua New Hampshire - Keene New Hampshire - Concord

Field Trip Date (Monday, Tuesday or Wednesday only)

1st Choice Comments 2nd Choice 3rd Choice

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