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2018-2019 Education Program Registration Request (and Summer Requests)
Use this form to request a presentation either at your school or at The Gardens. You will be contacted by The Gardens' education staff to confirm booking of your program. Payment is due 30 days before your scheduled presentation. (If you are in MDUSD or MUSD, you may qualify for full funding of the starred classes ***. Please indicate your interest in these classes by adding Andeavor grant to the Other questions or Notes section.)
Email address *
Name of School or Organization *
Your answer
Address *
Your answer
Program Requested *
CCWD Water Education is fully booked for the 2017-18 school year - check back with us for 2018-19 dates!
Grade Level *
Your answer
Number of Classes *
Your answer
Number of Students per Class *
Your answer
Where would you like the presentation(s) to take place? *
Preferred days, dates, times, etc. *
Your answer
Your school's Bell Schedule: *
Your answer
Primary Contact Person Name: *
Your answer
Primary Contact Email
Your answer
Primary Contact Phone *
Your answer
Teacher 2
List FIRST and LAST name and EMAIL for each teacher who will be participating. Eg. Mary Smith, smith@gmail.com
Your answer
Teacher 3
FIRST & LAST name, EMAIL
Your answer
Teacher 4
FIRST & LAST name, EMAIL
Your answer
Teacher 5
FIRST & LAST name, EMAIL
Your answer
Teacher 6
FIRST & LAST name, EMAIL
Your answer
Special Needs?
Are there any special needs we should be aware of for your classes?
Your answer
Other Questions or Notes
Your answer
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