LandHealth Education Request Form
Request a program by completing this form. Questions? Email anisa@landhealthinstitute.org
Your school or group name: 
Your answer
Location of your school or group:
Your answer
Primary contact name: 
Your answer
Primary contact email: 
Your answer
Primary contact phone number:
Your answer
Age or grade level of participants
Your answer
Estimated # of Participants (Limited to 30) 
Your answer
What program are you interested in booking?
What educational goals do you have for this field trip? What is it you are hoping your group will learn? 
Your answer
Are you able to provide at least 1 adult chaperone for every 10 youth?
Would you prefer LandHealth to come to your campus and teach a class, rather than go on a field trip? What environmental content are you looking for and do you have a viable outdoor classroom space?  
Your answer
Do you receive our e-newsletter?
If not, would you like us to add you to it so you can stay in touch and up to date with all our program offerings?
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