Developmentally Disabled Adult Outing Request Form
To register for a visit to Discovery Park of America, please fill out this form. We will contact you to confirm your trip within 5 business days to confirm your reservation.
* Required
Who Are You?
Please complete all fields. If we don’t have all of the information we need, we cannot book your trip!
Organization Name
*
Your answer
Licensing State
*
Your answer
License Number
*
Your answer
Organization Address
*
Your answer
Organization City
*
Your answer
Organization State
*
Your answer
Organization Zip
*
Your answer
Organization Office Phone Number
*
Including extension if necessary.
Your answer
Organization Office Fax
Your answer
Point of Contact
*
Your answer
POC Cell Phone
*
Your answer
POC Email Address
*
Your answer
Secondary Point of Contact
*
Your answer
Secondary POC Cell Phone
*
Your answer
Secondary POC Email Address
*
Your answer
Are you tax exempt?
*
(If you are tax exempt, you must send us a copy of your tax exempt certificate. We cannot process your request without it! You may fax a copy to 731-885-7276 or email a copy to
education@discoveryparkofamerica.com
)
Yes
No
Tax ID#
Your answer
Planned Date of Visit
*
MM
/
DD
/
YYYY
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