Schedule a Program

Request A Program Form

Demographic Information:

Last Name (Required)

First Name (Required)

E-mail (Required)

Phone

School / Organization / Group Name: (Required)

Address: (Required)

Address where program would take place

City: (Required)

State (Required)

Zip: (Required)

Program Request:

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Program

Select the program you are requesting.

T.R.U.E Blue
Macro Critter Count
KC Clean Stream
Litter Pick Up
Waterfestival

Date: Option 1

First Preference

Month

Day

Year

Time:

First Class Start

Start Hour

Start Minutes

Start AM/PM

End Hour

End Minutes

End AM/PM

Time:

Last Class Start

Start Hour

Start Minutes

Start AM/PM

End Hour

End Minutes

End AM/PM

Date: Option 2

Second Preference

Month

Day

Year

Time

First Class Start

Start Hour

Start Minutes

Start AM/PM

End Hour

End Minutes

End AM/PM

Time

Last Class Start

Start Hour

Start Minutes

Start AM/PM

End Hour

End Minutes

End AM/PM

Grade Level

The grade level of the students who will be participating in the program

K-2
3-5
6-8
9-12

Number of Classrooms (Required)

Number of Particpants (Required)

Maximum Number of Participants being requested for the program

Comment:

Please provide any additional information that you would like us to know about your request?

SCHEDULE A PROGRAM

Request A Program Form

Demographic Information:

Program Request: