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2. Name of School or Youth Group*
4. Address of School or Youth Group*
6. Contact First Name*
7. Contact Last Name*
9. Your Email*
10. Your Phone*
12. Emergency Contact Phone*
14. Grade or Age Range of Group*
15. Approximate Number of Students*
    ($7 each)
17. Approximate Number of Teachers/Employees*
18. Approximate Number of Adults/Parents*
    ($10 each)
20. Preferred Date of Visit*

    1. February 8th
    2. February 9th
    3. February 10th
    4. February 11th
21. Second Choice Date of Visit*

    1. February 8th
    2. February 9th
    3. February 10th
    4. February 11th
23. Tax Exempt?*

    1. Yes
    2. No
24. Tax Exempt Number
26. Method of Payment*
    -- Select One --CashCredit CardHandwritten CheckPurchase Order

    Unable to accept pre-printed checks.
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field