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Science in the Park Special Education Registration

1. Grade Level *This question is required.

2. Date of Requested Trip *This question is required. This question requires a valid date format of MM/DD/YYYY.

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3. School Name *This question is required.

4. School Phone Number *This question is required.

5. School Address *This question is required.

6. # Students Attending Program ($10.00 per student) *This question is required.

An estimated number of students is expected 5 days before your trip date. You will be invoiced after the program for the number of students in attendance or your estimated number minus 10%, whichever is greater. Teachers and chaperones are free.

7. Lead Teacher Name *This question is required.

8. Lead Teacher's Email Address *This question is required. This question requires a valid email address.

9. Lead Teacher's Cell Phone Number (for day-of communication) *This question is required.

10. Bookkeeper Name *This question is required.

11. Bookkeeper's Phone Number *This question is required.

12. Bookkeeper's E-mail Address *This question is required. This question requires a valid email address.

13. Emergency Contact Name *This question is required.

14. Emergency Contact Phone Number *This question is required.

15. Emergency Contact E-mail Address *This question is required. This question requires a valid email address.

16. Special Needs Description and Accommodations *This question is required.

17. Modifications Needed *This question is required.

18. Will aides be attending? *This question is required.

19. Any other information we may need? *This question is required.

"In Class" - This program includes hands-on instruction and time in our Discovery Lab with animal furs, skins, feathers, shells, skulls, microscopes and our animal track sand tables. All equipment and material will be brought to your school and set up in an available area.

* "In Park" - This program allows students to enjoy the beauty of our streams, trails, fields and creeks to explore Ecosystems and Habitats, Soil, Rocks, Animals and Plants. Our In Park program locations vary on student needs and accessibility.

20. Please mark the lesson you would like us to lead:
* In Park Program *This question is required.

Elementary
Middle School
High School