The Wall That Heals - group visit request form
You will be contacted by email and/or phone to confirm your request.
 Thank you for your interest in visiting The Wall That Heals.
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Contact Name *
Number in group: *
School or Organization: *
Grade or age level: *
Primary Phone: *
I agree to bring one adult per every 10 children under age 12 to chaperone my group.       (Note:  The Wall That Heals is recommended for grades 3 and over.)
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Secondary Phone:
E-mail address:
(if you do not have an e-mail enter NONE below)
Preferred day: *
Preferred time: *
Required
Does your group have special needs?
Please describe so that we can serve you better.
Will your group arrive by bus? *
Are there other concerns or questions you have?  
Submit
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