History Take Out Program Request Form
For educational groups looking to book an in-classroom facilitation, Moving Day: Colorado’s Migration Story or Western Work: Colorado Industries of the Past.
School Information
School Name *
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Billing Address *
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City *
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Zip *
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School District *
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School's Main Phone Number *
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Does the school qualify for Title 1 status? *
Teacher Contacts
Please provide the teacher's name(s) so that we can provide all the information needed for their in-classroom program.
Main Teacher's Name *
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Main Teacher's Email *
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Additional Teacher's Name
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Additional Teacher's Email
This is to ensure information is received by all teachers booking the program.
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Planning Your History Take Out
Duration: 60 minutes or 40 minutes for ECE and Kindergarten Classes. Please note a central feature of the program is a large 7’ x 9’ map of Colorado. We prefer being in either a gym, cafeteria, or a classroom where desks moved to the side of room. No audio/visual equipment needed.
Select Program (s) *
Descriptions of programs are provided below
Grade *
The History Take Out Programs are designed for 3rd and 4th (Although it can be adapted for other grades)
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Number of Classes *
For classes under 30 students we can facilitate up to 6 programs within one day. For classes over 30 we will facilitate up to 3 programs within one day.
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Number of Students per Class *
Each class needs at least 10 participating students to conduct a program
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Preferred Dates
Please select a date from September to May for a History Take Out Program
First Choice *
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Second Choice *
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Third Choice *
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Preferred Time or Schedule for Day *
We prefer to stay in one place and have classes rotate through. Ideally classes are back to back, no more than a 30 minute gap between classes.
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Any students with special needs/ESL *
Comments
Please list specific needs for your ESL or Special Needs students and we'll do our best to accommodate your group.
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Where should our facilitator park? *
Required
Notes, special accommodations, etc.
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Payment Information
Cost: $90 for the first class (maximum 30 students), $75 each additional class. Limited financial assistance is available for Title I schools. Additional travel fees may apply.

Once we process your request we will send an invoice and confirmation. Payment is due 2 weeks after receiving the invoice. Our class facilitators can not handle payment on the day.

Cancellation notice of 3 weeks is required for all programs to receive a full refund. Cancellations with less than 3 weeks notice are non-refundable but may be rescheduled within a 12-month period. If the classroom program is cancelled due to inclement weather, schools will be given the opportunity to reschedule if possible or the payment will be returned in full.

Name of Person Handling Payment *
Your answer
Phone *
Person responsible for payment's phone number
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Email *
Your answer
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