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Dunes Learning Center School Year Program Request Form
Please complete the information below. Requests can be made up to 12 months in advance. Be certain to provide the three best possible dates (in at least two different months) for your group to attend a Dunes Learning Center program. You will be contacted to confirm dates once school-year scheduling begins. We will do our best to accommodate your first choice of dates. Your flexibility and understanding in this process are greatly appreciated.
School Name
Your answer
School address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
School Phone
Your answer
School Fax
Your answer
School Website
Your answer
Dunes Learning Center program you are requesting
i.e. Frog in the Bog, Winter Ecology, etc. Include season and year.
Your answer
Lead Teacher(s) or Contact Person
Your answer
Primary Contact
(Name, Phone, Email)
Your answer
Secondary Contact
(Name, Phone, Email)
Your answer
Lead Teacher Summer Contact Information
(If same as above, type “same”)
Your answer
Alternate phone number(s)
(So you can be reached during the summer)
Your answer
Participant Information
Tell us about your group
# of Male Students
Your answer
# of Female Students
Your answer
Grade Level / Age
Your answer
Requested Program Dates
Please be sure to request dates in at least two different months. If you plan to request adopt-a-school funds for your school, please note that due to high demand, Dunes Learning Center may not be able to grant tuition assistance during the months of September, October, April and May.
1st Choice:
Your answer
2nd Choice:
Your answer
3rd Choice
Your answer
“Black-Out” Dates
Dates that the school is unable to attend
Your answer
Submitted By
Your answer
Date Submitted
Your answer
Submit
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