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770.992.2055
9135 Willeo Rd Roswell, GA 30075
Monday - Saturday 10AM - 5PM
Sunday 12PM - 5PM

Wildlife Clinic Hours
Monday – Saturday 10AM – 4PM
Sunday 12PM – 4PM
General Admission
$15 Adults | $11 Seniors (Ages 65+) & Students (Ages 13 -18) | $9 Children (Ages 3 -12) | Children 2 & under are free

Tickets
Support Us
Happenings
Membership
Calendar

Name(Required)

First Last

Organization

Permanent Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Web URL (If available)

Phone(Required)

Cell(Required)

Email(Required)

Fax

CONCEPTUAL PLAN

Contestants will be selected based on construction types, portfolio, and incorporation of natural elements. We strive to find a balance between construction types.

If you have any examples of your work, please attach to your application or share a website where they can be viewed:

File

Max. file size: 50 MB.

Please describe what materials you would plan to use to create your Fairy House, including how you plan to make your house durable to the elements and the public throughout the course of the exhibit:(Required)

Construction Materials

Please describe how you would plan to include natural elements in your Fairy House/Gnome Home:(Required)

Incorporating Nature

While not required, visitors love a backstory that goes along with a House. If you have any ideas on your story, please describe:

Background Story

1. CONTRACT:

The following rules and regulations become binding upon acceptance of this contract between the Contestant or Team Captain (Vendor), its employees and agents, and the Chattahoochee Nature Center (CNC)

2. SPACE ASSIGNMENTS:

Space will be assigned to Vendors. CNC reserves the right to assign or alter exhibit locations as it deems advisable and in the best interest of the exhibit.

3. PRIZES:

Vendors must submit a W9 with their entry form in the event that the entry wins a prize. Prizes are to be awarded by CNC to the Vendor by check no later than the close of the exhibit on February 28, 2023. Vendors may elect to waive their prize winnings as a donation to CNC if they choose.

Prizes(Required)

I will submit W9 and receive a prize

I choose to waive my prize

4. CANCELLATIONS:

Cancellations must be requested in writing and received on or before November 17, 2022. Requests should be made to Farah McIntyre at f.mcintyre@chattnaturecenter.org.

5. SAFETY:

Any/all construction materials shall be in good operable condition and will be reviewed by CNC upon installation.

6. USE OF EXHIBIT SPACE:

(A) Vendors will be asked to check on their fairy house once per month over the duration of the exhibit. Vendors will receive three passes to show at admissions to be admitted at no charge for the purpose of checking on the display. Vendors may maintain their exhibit only during regular operating hours of CNC. Pass is to be used by Vendors only. (B) Business/company/individual logos or other promotional information may only be included in the exhibit upon entry under the Business/Corporate category. All exhibits must fit in the space provided. (C) Vendors must hold themselves to the highest standards of professionalism while maintaining the exhibit during operating hours, including adherence to CNC policies put into place to reduce the risk of COVID-19 community transmission. For more information please visit the CNC website. This includes: Staying home when appropriate: please stay home if you have COVID-19, are exhibiting symptoms of COVID-19 or have had close contact with a person with a confirmed or suspected COVID-19 case. (D) Vendors shall arrange their exhibit so it does not cause any safety issues or damage the natural environment in any way. (E) Vendors must remove all items between 3/1/2023 and 3/10/2023 at 5PM.

7. AMENDMENTS TO REGULATIONS:

Any and all matters and questions not specifically covered by the articles in this contract shall be subject to the decision of CNC. They may, in the interest of the exhibit, amend the aforementioned items covered by this contract at any time, and notice thereof shall be binding on Vendors equally with the foregoing rules set forth in this contract. CNC reserves the right to refuse space.

Consent(Required)

By checking this box I agree to the listed rules and regulations above.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Phone(Required)

Cell

Phone(Required)

Home

Emergency Contact(Required)

Phone

Emergency Contact(Required)

Relationship

If you are under 18, please give age and birth date

MM slash DD slash YYYY

Educational Background(Required)

Are you currently attending school? Which one?

Supplemental educational courses/certifications

Current occupation/employer:(Required)

Previous volunteer experience(Required)

Hobbles/skills/interests: (please check any that apply)

Hobbies

Acting/storytelling

Animal rehabilitation

Arts & crafts

Computer skills

Construction/Carpentry

Hobbies

Costume design

Ebay selling

Education

Event Planning

Gardening

Hobbies

Graphic Design

Hens/livestock

Arts & crafts

Hospitality/Events

Interior design/decorating

Hobbies

Photography

Repair/Handyman

Scouting background

Sewing

Silent auction

Hobbies

Languages/translation:

Sign Language

Music performance

Nature crafts

Outdoor cooking

Hobbies

Trail maintenance

Videography

Writing articles/blogging

Additional Hobbies or Skills

Current volunteer needs at the CNC (please check any that interest you) Long-Term Commitments (regular, recurring weekly or monthly volunteer positions)

Horticulture

Hobbies

Unity Garden | Tuesday and Thursday 8-11AM (9AM-12PM in winter) | A community garden that grows fresh food for donation to a local food pantry. Work with others to plant & harvest produce year round.

Invasive plant removal | These dates occur monthly, usually on a Saturday or Sunday | Look for volunteer emails for more information

Native Plant Gardening Wednesday | 8-11AM (future Fridays planned) Maintain the native plant gardens with nature in mind. | Duties may include: weeding, mulching, watering, planting, or grooming plants.

Doccent

Hobbies

Docents work a variety of schedules, including weekends. | They are expected to commit to working ~4 hours per month Docent orientation and training occurs twice a year: late summer and late winter. Continuous training is on-going. | Docent selection may involve an on-site or phone interview, as well as a background check.

Wildlife

Hobbies

Applicants must be 18 or older. Applicants must be willing to obtain a current tetanus shot or provide proof of one in the last 10 years. There is a wait time of approximately 1 year for volunteer spots in wildlife. When an opening arises, all waitlisted volunteers that have indicated availability for that shift will be contacted for an interview.

If selecting Wildlife; Please list available times

Short-Term Commitments (special events, clerical assistance, tabling, etc. - please check any that interest you)

Hobbies

Clerical/Mailings

Parking lot management at events

Tabling/Off-site events

Driving (drop off/pick up items)

Photography

Hobbies

Farmer’s Market

Organization (store rooms, etc.)

Silent auctions solicitation/planning

Invasive Plant removal days

Parade character (costumed)

Hobbies

Special Events/Festivals at the CNC

Data Entry

Do you have any physical limitations or allergies, or are you under any course of treatment which might limit your ability to perform certain types of work?(Required)

Yes

Since you answered yes, please explain?

Please give two references whom we may contact: Please provide Phone & Email

Name(Required)

First Last

Email(Required)

Name(Required)

First Last

Email(Required)

Consent

By checking this box I acknowledge this is my signature and the information on this form is correct. I also give consent to Chattahoochee Nature Center for the following:

The above application has been completed voluntarily, and I certify that all statements and representations are true and correct. I understand that individual volunteers at the Chattahoochee Nature Center must consent to a background check, sign a liability waiver, as well as possibly complete an on-site interview before beginning any volunteer work at CNC. I understand that I am not an employee and will not be paid for my services as a CNC volunteer. I agree to abide by all the volunteer policies and procedures of the Nature Center.

Consent

I agree to the following

The undersigned hereby acknowledges that participation in recreational and other activities
conducted by or in conjunction with the Chattahoochee Nature Center, and travel to and from such
activities, involves inherent risks of physical injury, illness, death or loss of personal property, and the
undersigned assumes all such risks, including risks associated with activities conducted in remote
locations. In consideration of the mutual benefits derived from participation by the undersigned with
activities conducted by orin conjunction with the Chattahoochee NatureCenter,the undersigned hereby
absolves, releases and waives any and all liability, claims or demands against the Chattahoochee Nature
Center and its officers, directors, agents, trip leaders, volunteers, contractors and employees from any and all
claims, demands, rights and causesof action of whatsoever kind and nature arising fromand by reason
of any and all known and unknown,foreseen and unforeseen bodily and personal injuries, including
death,damagetoproperty,and the consequencesthereofresulting from orrelating to participation by the
undersignedinanyactivities conducted by or in conjunction with the Chattahoochee Nature Center. I
understand that the Chattahoochee Nature Center is not responsible for vandalism, break-ins, or theft of
personal property. I also understand that the Chattahoochee Nature Center does not provide insurance for
participantsin its activities and the undersigned isrequired to and shall carry such insurance adequate for any
eventuality forinjury or illnessas a result of suchactivities. I certifythat I ameighteen (18) yearsof ageorolder,
or my parent or guardianhas signed below, and that I ormyparent and/orguardianhaveread the above carefully
before signing.
HEALTH & SAFETY WARNING AND DISCLAIMER
The undersigned acknowledges that participating in Chattahoochee Nature Center programs or accessing
Chattahoochee Nature Center facilities could increase the risk of contracting illnesses, including, without
limitation, COVID-19. Chattahoochee Nature Center in no way warrants that illnesses and/or infections
(including, without limitation, COVID-19) will not occur through participation in Chattahoochee Nature
Center programs of accessing Chattahoochee Nature Center facilities.
RELEASE AND WAIVER OF PHOTO
Do you give the Chattahoochee Nature Center permission to use your photo and itslikenessfor any
and all print and video purposesit deems necessary or desirable? The Chattahoochee Nature Center
will not be required to reimburse you for use of your photo or its likeness.

VOLUNTEERS ONLY: If you are volunteering on behalf of an organization or group, please indicate name of organization/group

How did you hear about us?

CNC visit

I am a current CNC member

How did you hear about us?

Referred

Volunteer Fair

Previous experience as a group volunteer at CNC

How did you hear about us?

CNC website

Agency/School:

Previous experience as a group volunteer at CNC

other:

Date

MM slash DD slash YYYY

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

School Name(Required)

Major(Required)

T-shirt Size(Required)

Small

Medium

Large

X Large

Special Dietary Needs(Required)

Permanent Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you need time off during the summer?(Required)

Yes

Dates of training/employment fall between May 18, 2022 and August 5, 2022. Please indicate if there is any time during this period when you would not be able to work. Hiring preference is given to employees who are able to commit to the entire summer.

Since you answered yes, when?

General Information(Required)

Training: Pre-Camp May 18-20 and Camp Training Week May 23-27

Camp Dates are May 31-Aug 5

CPR/First Aid: Sat, May 14 @11:30AM or Fri, May 20 @ 10:30AM. Distance learning with a skills test at CNC

Camp positions work longer than a traditional work week. (40-50+ hour week)

Summer hours for the 2022 season Arrive 7:30-8:30AM, Leave 4:30-6:30PM

I understand there is no smoking/vaping on CNC grounds

I acknowledge Camp Kingfishers dress code

I am comfortable handling snakes

I am willing to canoe & swim with kids

NO Camp on Memorial Day

No campers on July 4th, but I understand we will have a professional development day.

I understand part of my job is cleaning. Sweeping, mopping, plunging toilets, cleaning up after campers.

For staff who work with older campers there will be possible option of Late evening programs for campers.

The last “BIG” day of camp we will do a deep clean of camp and have our end of summer banquet I know Friday July 31 will be a very long day

I understand part of my position is responding to Debby’s emails.

I have read & acknowledge all of the general information for summer 2022. If I have any concerns I will contact Debby

Logistics for the summer, please check each box to acknowledge each item.

I am applying for the following position(s):(Required)

Head Counselor* (must be 21 years of age)

Camp Counselor

Arts & Crafts Instructor

Heron Pond Canoe Instructor** (Part Time)

Travel Program Counselor* (must be 22 years of age)

Owlet Counselor (part time)

Admin Support

Archery Instructor (Part Time)

Canoe Instructor/ High School Leadership Instructor* ** (must be 21 years of age)

Lifeguard **

Environmental Education Specialist*

Sub Counselor

Please read job descriptions on website. Feel free to select more than one. KEY: *Please fill out additional application obtained from Debby **Additional training provided

Since your job of choice is subbing, please list when you would be able to be at camp:(Required)

Specialist/Travel Program

I have a solid idea of what this job looks like and the skills expected of me for this job

I have questions about this position or would like to learn more to see if I’m a good fit

I am lifeguard certified or willing to become one

If you are applying for a Specialist or Travel Program position, please check the boxes that apply to that position.

Travel program

I have a clean driving record

I feel comfortable driving a 12 passenger van

I meet the age requirement for this position.

Canoe

Yes

Archery

I understand there is an online training course I will need to complete in order to become certified by May 20, 2022

Pool

I am already certified as a lifeguard

I need certification. I feel confident in my swimming skills that I can pass the pretest for certification.

I am comfortable learning how to maintain chemical levels and cleaning with bleach

Canoe Training

I will participate in the additional Canoe Training (date TBD but will be sometime in May).

What are you hoping to get out of this summer?(Required)

What is your age group of choice and why do you feel you are a great fit for them? If there is an age group you feel uncomfortable working with why and how can we help you gain confidence with this age?(Required)

What do you like about the position(s) you have chosen?(Required)

If you had to give yourself a grade for last summer, how would you rate your personal performance? Why did you give yourself the grade you did?(Required)

How are you planning to improve your performance as a staff member at camp this summer?(Required)

I expect returners to lead by example. What areas are you an “expert” in and how are you planning to lead the way and leave your mark this summer?(Required)

How can Camp help you grow?(Required)

How can the Camp K admin team support your growth?(Required)

What was your favorite part of camp last summer?(Required)

What part of your job last summer did you feel like you thrived in?(Required)

What is one part of your job that stresses you out?(Required)

What part of last summer frustrated you the most?(Required)

Over the last 9 months what did you do with your life? Tell us about 2 things you have done, accomplished or learned since we saw you last. How will you apply those lessons/skills to your work at Camp?(Required)

Share a moment recently when you felt like an adult… or at least the most adultist person around. What was it and what did you learn about yourself in that moment?(Required)

Every year there are improvements that can be made to camp. What do you see as an improvement to make camp better? What suggestions do you have that could help this area improve?(Required)

As a returner I understand the following

Please check each box to acknowledge each item.

Each year is different(Required)

By checking this box I realize that each year at camp is different as new campers and new staff bring a new dynamic and energy. While there are constants, it’s important to remember this dynamic as you return. Returners bring a lot to the table and can pass on a lot from prior experiences. Returning to camp with an open and welcoming attitude helps to make the transition to a new summer easier and benefits everyone on our team.

Lead by example(Required)

By checking this box I realize that as a returning staff member to Camp Kingfisher I understand that I will be expected to lead by example, speak up if I see something wrong at camp, be a mentor to newer staff and campers, approach change with a positive attitude. I also understand that I will be asked to be an active participant in staff training this includes being asked to help lead in some training sessions.

Voluntary Disclosure

Have you ever been arrested or indicted for any form of child abuse, misconduct, or for any behavior that might be considered inappropriate for someone who will be working with children?(Required)

Yes

Have you ever been convicted or pleaded guilty to child abuse or any other felony?(Required)

Yes

Since you chose yes, please explain(Required)

Consent(Required)

By checking this box I realize that I am giving consent for Camp Kingfisher at the Chattahoochee Nature Center to obtain references and a criminal background check on me.

Consent(Required)

By checking this box I realize that I am giving consent for Camp Kingfisher at the Chattahoochee Nature Center to obtain references and a criminal background check on me.

Please list a few days/time we can contact you by phone to chat about this upcoming summer?(Required)

Any additional comments or concerns?

CAPTCHA

"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone*

Email*

(You will receive communication from Camp Kingfisher - Please use an email address that you check often.)

School You Are Currently Attending*

Current Grade (2021-22 school year)*

Age*

Birth Date*

MM slash DD slash YYYY

Tshirt Size*

Small

Medium

Large

xLarge

Are you (or your family) a member of the Chattahoochee Nature Center?*

Yes

How did you hear about the LIT program?*

Please list any dietary needs*

Camp is a rigorous program that is physically demanding. Hiking, swimming, and canoeing are some of the required activities. Please list any special needs or concerns.*

Have you ever been canoeing?*

Yes

If not, are you willing to learn?*

Yes

Sessions for which you are applying:*

Session 1: June 6th – July 1st

Session 2: July 5th – July 29th (no camp on July 4th)

Choose one additional week to assist at the canoe ponds. (9AM – 1PM required)*

May 31st - June 3rd

August 1st - August 5th

Are there any days off needed during the session you have signed up for? Attending 85% of the session is required.*

Please describe any previous volunteer experience you may have. Include where, for how long, and what kind of work you performed.*

Describe any experience you have teaching or working with children.*

Please tell us why you want to be a Camp Kingfisher LIT.*

As an LIT, you are a role model for campers. What attributes would you bring to camp in order to be a great role model?*

What would make you an asset to the LIT program?*

In what ways would you like to grow in your leadership abilities through Camp Kingfisher’s LIT program?*

Describe yourself in three words. What makes you describe yourself this way?*

Applicant Consent*

By checking this box I acknowledge this is my signature and the above information is correct

Parent/Guardian Section

Parent Name*

First Last

Consent*

I agree to the Bright from the Start Exemption Notice Below:

I understand that Camp Kingfisher at the Chattahoochee Nature Center is not licensed under the State of Georgia’s Bright from the Start. Camp operates under an exemption from licensure Rule 591-1-1-1-.46, exemption rule #6 & #7.

Parental Consent for Application*

I agree to let my child apply for the Camp LIT position

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

School Name(Required)

Major(Required)

T-shirt Size(Required)

Small

Medium

Large

X Large

Special Dietary Needs(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you need time off during the summer?(Required)

Yes

Since you answered yes, when?(Required)

I am applying for the following position(s):(Required)

Camp Counselor

Lifeguard

Canoe Instructor

Travel Program Counselor* (must be 22 years of age)

Arts & Crafts Instructor

Admin Support

Canoe Instructor/ High School Leadership Instructor* (must be 21 years of age)

Environmental Education Specialist*

Archery Instructor

Please read job descriptions on website. *Position requires additional application section. Email camp@chattnaturecenter.org with subject line “Additional Application Request” and specify the job you are interested in.

Based on your choice(s) tell us what makes this position right for you and for Camp Kingfisher(Required)

Please list schools/programs where you have studied natural sciences, environmental studies, or early childhood/elementary education. Please also list any relevant certification you hold.(Required)

Please attach files of your certifications (if any)

Drop files here or

Max. file size: 50 MB.

Please list all experiences working with children(Required)

Please attach your resume(Required)

Max. file size: 50 MB.

How did you hear about Camp Kingfisher?(Required)

During the summer, you will be expected to teach on variety of topics.

In each section please select the activities you are confident in teaching, possibly could teach, or cannot teach.

Hidden

Yes, I can teach the following:

Animal sounds/calls

Basic needs of animals

Bird house building

Bird feeder building

Bird watching

Butterfly ID

Camping

Canoeing

Chattahoochee natural history- river flow, inhabitants, and natural resources

Fire making

Flower pressing

Food web (tertiary levels, producers, consumers)

Georgia’s eco-regions

Hiking/backpacking

Insect ID

Leave no Trace

Macro Invertebrate Pond Study

Mammal Skull Study

Native Georgia flowers, shrubs, and trees

Nature Arts & Crafts

Nature journaling

Nocturnal adaptations of native Georgia animals

Orienteering

Primitive skills

Recycling

Reuse art

Shelter building

Snake ID

Soil Testing

Storytelling

Swimming

Terrariums

Tie-Dye

Wilderness survival

Wildlife tracking

Please make sure that you select "Yes", "Possibly", or "No" for every topic listed.

Hidden

Possibly I could teach this – but I’d need some guidance:

Animal sounds/calls

Basic needs of animals

Bird house building

Bird feeder building

Bird watching

Butterfly ID

Camping

Canoeing

Chattahoochee natural history- river flow, inhabitants, and natural resources

Fire making

Flower pressing

Food web (tertiary levels, producers, consumers)

Georgia’s eco-regions

Hiking/backpacking

Insect ID

Leave no Trace

Macro Invertebrate Pond Study

Mammal Skull Study

Native Georgia flowers, shrubs, and trees

Nature Arts & Crafts

Nature journaling

Nocturnal adaptations of native Georgia animals

Orienteering

Primitive skills

Recycling

Reuse art

Shelter building

Snake ID

Soil Testing

Storytelling

Swimming

Terrariums

Tie-Dye

Wilderness survival

Wildlife tracking

Please make sure that you select "Yes", "Possibly", or "No" for every topic listed.

Hidden

No, I don’t think I could teach this:

Animal sounds/calls

Basic needs of animals

Bird house building

Bird feeder building

Bird watching

Butterfly ID

Camping

Canoeing

Chattahoochee natural history- river flow, inhabitants, and natural resources

Fire making

Flower pressing

Food web (tertiary levels, producers, consumers)

Georgia’s eco-regions

Hiking/backpacking

Insect ID

Leave no Trace

Macro Invertebrate Pond Study

Mammal Skull Study

Native Georgia flowers, shrubs, and trees

Nature Arts & Crafts

Nature journaling

Nocturnal adaptations of native Georgia animals

Orienteering

Primitive skills

Recycling

Reuse art

Shelter building

Snake ID

Soil Testing

Storytelling

Swimming

Terrariums

Tie-Dye

Wilderness survival

Wildlife tracking

Please make sure that you select "Yes", "Possibly", or "No" for every topic listed.

Do you play an instrument?(Required)

Yes

Do you sing?(Required)

Yes

Would you be willing to play or sing in front of kids at camp?(Required)

Yes

What instrument do you play?(Required)

Why do you not sing?(Required)

Please tell us about a time you had to teach a group of elementary aged students. What did you teach and what techniques did you use?(Required)

What challenges (if any) did you have?(Required)

Are there any camp-related activities that you feel you could bring to Camp Kingfisher? Where or how did you develop this expertise?(Required)

What is one ecology/nature topic you are passionate about? How would you teach it to school aged children?(Required)

What do you think your greatest strengths will be as a camp counselor?(Required)

What do you think your greatest challenges will be as a camp counselor?(Required)

What unique contributions can you make to our summer camp program?(Required)

What or who inspires you? Why?(Required)

Why do you want to be a counselor at Camp Kingfisher, an environmental education camp?(Required)

Why would you make you a great staff member?(Required)

Camp Experience: List all camps you have attended as a camper or staff member:(Required)

Have you ever been arrested or indicted for any form of child abuse, misconduct, or for any behavior that might be considered inappropriate for someone who will be working with children?(Required)

Yes

Have you ever been convicted or pleaded guilty to child abuse or any other felony?(Required)

Yes

Since you chose yes, please explain(Required)

Consent

By checking this box I realize that I am giving consent for Camp Kingfisher at the Chattahoochee Nature Center to obtain references and a criminal background check on me.

CAPTCHA

Name*
First Last
Zip Code*
Email*
Please select your area of interest*
- Camp
- Donations/Sponsors/Fundraising
- Education
- Horticulture
- Marketing/Website/Public Affairs
- Concerts and Evening Events
- Venue Rentals
- Wildlife
- Other
CAPTCHA

What type of program are you interested in booking?
Name*
First Last
Email*
Phone*
Name of School/Organization*
Age range/grade level of participants*
How many children will be participating in the program?*
How many adults will be participating in the program (including teachers, chaperones, and school staff)?*
Choice of Program(s)*
Preferred Date 1*
MM slash DD slash YYYY
Preferred Date 2*
MM slash DD slash YYYY
Preferred Date 3*
MM slash DD slash YYYY
What is your preferred program time?*
Do you have any topics of interest that you would like us to focus on?*
Is there anything else we should know?*
Name*
First Last
Email*
Phone*
Name of School/Organization*
Age range/grade level of participants*
How many children will be participating in the program?*
How many adults will be participating in the program (including teachers, chaperones, and school staff)?*
Choice of Program(s)*
Preferred Date 1*
MM slash DD slash YYYY
Preferred Date 2*
MM slash DD slash YYYY
Preferred Date 3*
MM slash DD slash YYYY
What is your Preferred Program Time?
Do you have any topics of interest that you would like us to focus on?*
Is there anything else we should know?*
What type of virtual program are you interested in?*
Name*
First Last
Email*
Phone*
Name of School/Organization*
Age range/grade level of participants*
How many children will be participating in the program?*
How many adults will be participating in the program (including teachers, chaperones, and school staff)?*
Choice of Animal*
Preferred Date 1*
MM slash DD slash YYYY
Preferred Date 2*
MM slash DD slash YYYY
Preferred Date 3*
MM slash DD slash YYYY
Do you have any topics of interest that you would like us to focus on?*
Is there anything else we should know?*
Name*
First Last
Email*
Phone*
Name of School/Organization*
Age range/grade level of participants*
How many children will be participating in the program?*
How many adults will be participating in the program (including teachers, chaperones, and school staff)?*
Choice of Program(s)*
Preferred Date 1*
MM slash DD slash YYYY
Preferred Date 2*
MM slash DD slash YYYY
Preferred Date 3*
MM slash DD slash YYYY
Do you have any topics of interest that you would like us to focus on?*
Is there anything else we should know?*

Name*
First Last
Email*
Phone*
Name of School/Organization*
Name of School/Organization*
How many children will be participating in the program?*
How many adults will be participating in the program (including teachers)?*
Choice of Program*
3 Preferred Program Dates*
Do you have any topics of interest that you would like us to focus on?*
Is there anything else we should know?*

Name*
First Last
Email*
Phone*
Name of School/Organization*
Age range/grade level of participants*
How many children will be participating in the program?*
How many adults will be participating in the program (including teachers)?*
Choice of animal:*
- Box Turtle
- Snake
- Gopher Tortoise
- Opossum
- Bird of Prey
3 Preferred Program Dates*
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