Scheduling Form for Education Session

Today’s date_______________________   Scheduler’s Initials__________________

Teacher’s Name______________________________________________________

School______________________________________________________________

District______________________________________________________________

County______________________________________________________________

Date of reservation_1st choice___________2nd choice_________                               Grade     3     4     5

Total number of classes from your school attending on this date _____________________________________________________________________

Names of other teachers attending  with  you______________________________________________________

_____________________________________________________________________

School Phone number _________________________________________________

Most frequently checked e-mail/s_________________________________________
__________________________________________________________________

School Fax _________________________________________________________

Cell Phone number/s___________________________________________________

Our program is 9:30am to 1:30pm - if this schedule does not work what time do you prefer?                           Arrival_________Departure time________

Will this be your first visit?          Yes       No

Do you have any special need students attending?            Yes       No

If yes, what accommodations?    Physical challenges, mental, vision/auditory challenges - please describe:______________________________________________________
___________________________________________________________________

Please  note - we require ALL children and adults to wear easily identifiable name tags.
A lunch break is included.  Plan on using our picnic area outside the building, if inclement weather - lunch will be inside the building.