Virtual Class Inquiry Form
Please complete this form to inquire about a class or video from the Roundhouse Aquarium
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Email *
The Roundhouse Aquarium
Teacher's First Name *
This is your first name. Not the Roundhouse instructors name
Teacher's Last Name *
This is your last name. Not the Roundhouse instructors name
Name of School *
Example: ABC Elementary
Address of School/City/State and Zip *
Example: 123 Main Street/El Segundo, CA 90245... **** MAKE SURE YOU PUT THE COMPLETE ADDRESS *****
Phone number of school *
Example: 310-379-8117
Your email address *
How many students' total will be participating in the virtual class? *
This is how many students will attend the class via zoom or google meet.
Grade level of students' participating in the virtual class? *
Example: 1st graders
Names of all the teachers who will be participating in the virtual class with you. *
Example: Mrs. Smith OR if you have several teachers put those names here with their emails.
FOR EXAMPLE. TEACHER 1. MRS. SMITH. MRSSMITH@LAUSD.NET  TEACHER 2. MR. MARVAL MRMARVAL@LAUSD.NET ETC ETC. 
In case we need to get a hold of you after school hours, please provide you cell phone number. *
This is in case we need to get a hold of you due to the zoom link not working or if we have an emergency and need to call you to update you. This is for internal use only.
1st choice of the date you prefer to have the virtual class provided by the Roundhouse Aquarium. *
This is the date you prefer. Make sure you fill out choice 2 and 3 as well. Sometimes your first choice is not available.
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2nd choice of the date you prefer to have the virtual class provided by the Roundhouse Aquarium. *
This is the 2nd choice you prefer. Make sure you fill out choice 3 as well. Sometimes your 1st and 2nd choice are not available.
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3rd choice of the date you prefer to have the virtual class provided by the Roundhouse Aquarium. *
This is your 3rd choice for a date.
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Preferred time you would like. Give 2-3 choices. *
Please make sure you put several times down. Sometimes your 1st choice for time is not available.
Are you a Key to the Sea teacher with Heal the Bay *
Which class are you interested in? Please review the list below to see the various classes that we offer. You can also go to our website. *
Select the videos that interest you. EACH VIDEO IS A $10.00 DONATION.  You can see previews by copying and pasting the following link into your web browser: https://www.youtube.com/playlist?list=PLeXAV-9xgtvUYWe-fjpOep_M9jBFpyzOK       After you select your video, Dawn will send you the link to donate. After you donate Dawn will send you the link for the video. *
Required
I understand that submission of this form does not guarantee or confirm my class, date and time. I also understand that fees may apply. A staff member will reach out to you to confirm your requested class. *
Required
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