2018 Auerfarm Program Reservation
Email address *
Contact name: *
Your answer
School/Organization: *
Your answer
Address: *
Your answer
Town *
Your answer
Telephone: *
Your answer
What program do you wish to schedule? *
Your answer
Date of program request: *
MM
/
DD
/
YYYY
Time of program: *
Time
:
Age/Grade of children *
Your answer
Number of children attending: *
Your answer
Number of adults attending: *
Your answer
Do you wish to reserve the picnic area *
Are there any special needs we should be aware of - allergies, walkers, wheelchairs, etc? *
Your answer
Notes:
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of 4-H Education Center at Auerfarm.