In what city, county, district, and state are your students primarily located? *
Phone number for your administrative office? *
Number of students *
What grades are represented in this group? Check all that apply. *
Primary contact *
Phone number *
Email Address *
Which virtual field trip lesson would you like to reserve? *
What date would you prefer to host the virtual experience? *
Please choose a secondary date.
What time of day is best for your group? *
Which virtual medium works best for you? *
Terms & Conditions
Before submitting this form, please read and accept the following terms:
1. As Discovery Park of America provides this opportunity at no cost to educators or students, abuse of this program, repeated cancellation of a preregistered virtual field trip lesson, or negligence in correspondence may result in your virtual lesson request being either rejected or cancelled at the discretion of the Education Director. 2. A confirmation email may be sent to the primary contact listed on this form. This confirmation, however, is not a guarantee that the date and time specified in this form will be available. Be conscious of additional correspondence from the Discovery Park education team within 3 business days. 3. If you believe that your form was not received or you have not received an email within 3 business days, email firstname.lastname@example.org or call (731)-885-5455.
Electronic signature of applicant:
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