Please complete the following form and we will call you within 24 hours to confirm your reservation.
When would you like to schedule a program?
Date
Time
Full Day
Half Day-Morning
Half Day-Afternoon
Half Day-Flexible
Evening Activity
Other
How Many Children in Your Group?
Less than 10
10-20
20-30
30-40
40-50
50+
Age Level:
Pre-school
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Mixed Ages-Elementary School
6th Grade
7th Grade
8th Grade
Mixed Ages-Middle School
High School
How Many Adults in Your Group?
0
1
2
3
4
5
5-10
10-20
20-30
30-40
40-50
50+
What is the primary purpose of your program?
School Field Trip
Girl Scout Outing
Boy Scout Outing
Birthday Party
Special Event
Other
How did you hear about us?
Referral
Schuyler County Visitor's Guide
EEAI Newsletter
Mailing
E-mail
Brochure
Craigslist
MySpace
Website (other)
Other
Which program(s) are you most interested in while visiting the Learning Center?
(select all that apply)
Amazing Animals
Bird Basics
Beaks & Feet
Creek Exploration
Who Eats Who?
Trees are Terrific
Rock On!—Geology
Surviving Outdoors
Habitat Connections
Incredible Insects
Lake/Pond Explorers
Map & Compass Adventures
Maple Syrup Sweetness
Out on the Prairie
Exciting Ecology
SURVIVOR: Predator/Prey
Seasonal Cycles
Simply Sense-ational
The Green Scene- All About Plants
Biodiversity 101
Earth Is Our Home
What's Up in Your Watershed?
Other
Proposed Program Site:
At what site would you like to schedule your program? (Some progam sites may limit the study you can choose.)
Peace of Earth Environmental Learning Center
Siloam Springs State Park
Argyle Lake State Park
Weinberg-King State Park
Wildwood Girl Scout Center
Jim Edgar Panther Creek State Fish & Wildlife Area
Other City/County/Private Park or Camp in your Area
(please specify)
Tell us how to get in touch with you:
School/Organization
First Name
Last Name
Address 1
Address 2
City
State
Zip Code
Home Phone
Best Time to Call:
Morning
Daytime
Evening
Cell Phone
Best Time to Call:
Morning
Daytime
Evening
Work Phone
Best Time to Call:
Morning
Daytime
Evening
Email Address
School/Organization
Additional Information, Questions, or Comments:
If you are attending a program at Peace of Earth Environmental Learning Center, go to "Map & Directions" and print out directions.
If you have scheduled a program at another site, other than Peace of Earth, directions and meeting instructions will be sent/emailed to you.
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