Classroom Program Request Form

Classroom Program Request

"*" indicates required fields

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

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