Distance Learning Online Request Form

BEFORE YOU SCHEDULE A DISTANCE LEARNING PROGRAM, take a look at our program page and choose which program fits your needs best. This request is for ONE class or group. Other classes or groups will have to complete a separate form.

First Name*: Last Name*:  
School/Organization Name*:  
Address*:
City*:Zip*:
Email*:  
Personal Cell Phone Number*:  
Grade*:  

Expected number of participants*:

(Max. number of participants is 35.)

  

We will be*:

In the Class Room

Disctance Learning 

  

Programs (check all programs you would like to schedule)*:

Trail Virtual Field Trip: Making a Home (40 minutes; Mondays and Wednesdays)

In-Classroom Education Outreach (Tuesdays and Thursdays)

 In-Classroom Education Outreach with Games (1 ½ hours; Tuesdays and Thursdays)

Scheduling: Museum staff will schedule you for the first available program slot that fits your schedule. You will receive an email to confirm your program date(s) before we finalize your program schedule. Programs must be scheduled 30 days in advance.

We would like the program on*:

1st Date:  

2nd Date: 

3rd Date:  

4th Date:  

5th Date:  

Perfered times*:

9am

10am

11am

12pm

1pm

Comments:
I have reviewed the distance learning policies sheet and agree to the conditions of this tour booking.*


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