School Name:
Teacher Contact 1:
Teacher Contact 2:
School Address:
City: State: Zip Code:
Telephone & fax 1:
Telephone & fax 2:
Email 1:
Email 2:
Best Time to Contact Teacher 1:
Best Time to Contact Teacher 2:
Grade(s) Participating:
Number of Students:
Program Date(s) First Choice: Second Choice:
Program Time: