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School or Organization*

School District

First Name*

Last Name*

Title

Email*

Phone*

Are you a first time requestor?

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Address of Presentation

Street Address*

City*

State*

Zip Code*

Class Details

Lessons run approximately 30-35 minutes for Pre-K and 40-45 minutes for K and up. If scheduling multiple classes, please allow five minutes between lessons for prep. Please list the times for each class you would like us to visit for the day.

Type of Request*

Room Number*

Must be able to remain in the same room if instructing multiple classes

Activity*

Total Number of Classes*

Class Start Time*

Grade Level*

Number of Adult Support*

End Time*

Number of Students*

Setup Time

Back Up Date 1*

Back Up Date 2*

Additional Requests

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