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.

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

This is a required question

Licensing State

This is a required question

License Number

This is a required question

Organization Address

This is a required question

Organization City

This is a required question

Organization State

This is a required question

Organization Zip

Please enter a number to continue.

This is a required question

Organization Office Phone Number

Including extension if necessary.

This is a required question

Organization Office Fax

This is a required question

Point of Contact

This is a required question

POC Cell Phone

This is a required question

POC Email Address

This is a required question

Secondary Point of Contact

This is a required question

Secondary POC Cell Phone

This is a required question

Secondary POC Email Address

This is a required question

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)

This is a required question

Tax ID#

This is a required question

Planned Date of Visit