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2. First Name*
3. Last Name*
5. Group Name*
7. Email Address*
8. Phone Number*
9. Preferred method of contact

   1. Email
   2. Phone
11. How would you describe your group?*

    1. School
    2. Scouts
    3. Other
12. How many people are in your group?
13. How many scouts are in your group?
14. What grade are your students/scouts?
16. How many classes are you bringing?
17. How many students are in each class?
18. Additional Teacher/Leader Names
20. Preferred Date Range*
    Preferred Date Range Start Date

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    Preferred Date Range End Date
    REMINDER: programs are scheduled on a first come first serve basis. It is possible that the dates you are interested are not available. Naturalist will reply with next available date and time.
21. If you have multiple and specific dates in mind, please list them here:
23. Preferred Time*
    Preferred Time Start Time

    —

    Preferred Time End Time
24. Preferred Location*
    -- Select One --Independence Lake County ParkRolling Hills County ParkCounty Farm ParkParker Mill County ParkFox Science PreserveOther
26. Please tell us what topic you want the program to be about, and any particular information you would like covered. *
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field