In-School Education Program Request Form

NOTE: This is not a reservation! A staff member will be in contact with you to discuss your school program request.

Name

First Last

Email*

Enter your email so our staff can contact you to discuss your school program request.

Phone*

Enter a phone number so our staff can contact you about your program request.

School/Org. Name*

Last

School Address*

Street Address Address Line 2 City State ZIP Code

What grade(s) is the program being presented to?

What is the grade range for this program? Example: Grades 1-3

Please select type of visit*

How many classrooms are being visited?*

Note that each visit will be one hour if no assembly is selected.

How many periods?

If it is one classroom, will there be multiple periods or one single session?

Topic Requested*

Please select the field trip topic you are interested in for your school group.

Requested Dates: Date One*

Please provide three possible dates for the field trip.

Requested Date: Date Two

Requested Date: Date Three

Requested Start Time*

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