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 *
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)
Tax ID#
Your answer
Planned Date of Visit *
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This form was created inside of Discovery Park Of America. Report Abuse
Google Forms