Virtual Class Inquiry Form

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Please complete this form to inquire about a class or video from the Roundhouse Aquarium

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. *

Example: 123 Main Street

City and State of School. *

Example: Manhattan Beach, CA

Zip Code of School *

Example: 90266

Phone number of school *

Example: 310-379-8117

Your email address *

Example: Dawn@abcschool.org

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.

YYYY

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.

YYYY

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.

YYYY

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.

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. *

Ocean Discovery Live VirtualTour, 30-60 minutes depending on the grade (Pre K-12th grade)

"The Ocean in your Bathtub" Virtual reading program, 1 hour (Pre K-5th)can be shorter for younger grades. Video alone is 15 minutes

All About Watersheds Virtual Program, 1 hour (6th -12th, can be adapted for 4th & 5th grade)

Plankton Up Close Virtual Program, 1 hour (6th - 12th, can be adapted for 4th & 5th grade)

Amazing Cephalopods Virtual Program, 1 hour (6th - 12th, can be adapted for 4th & 5th grade)

Watershed Connections Virtual Class , 45 minute classes x3 sessions (5th, can be adapted for other grades)

Other:

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. *

I agree this request is not confirmed nor guaranteed

Required

Send me a copy of my responses.

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