Classroom Program Request Form

What types of programs are you interested in?*
- Night Ninjas: Owls
- Bird Adaptations
- Bird vs. Human Skeletal Systems
- Bird vs. Human Digestive Systems
- Ecosystems Embodied: Nature's Choreography
Possible dates for class*
What time would you like to begin your class*
- 9:45 am
- 10:00 am
What is your county?*
What is your school district?*
What is your school's name?*
Does your school have Title 1 status?*
(If so, you may be eligible for tuition assistance)
- Yes
- No
Your name*
(who should we be in contact with)
Contact person's email address*
Contact person's cell phone number*
What grade level are the students?*
How many students will be attending?*
(Maximum 30, and please note we need 1 chaperone for each 5 students)
Please list any special needs or accommodations that we should be aware of