2018 Outreach Reservation Form
As of January 1, 2018, we will no longer be accepting over the phone reservations.

If you do not hear from our Education Coordinator within two weeks of filling out this form, please let us know by calling 920-448-5150 x 102 or emailing education@heritagehillgb.org

Please fill out one form per program type.

Email address *
School or Organization *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Teacher (Contact Person) *
Your answer
School Phone *
Your answer
Emergency Contact Number (Cell Phone) *
This will only be used if needed to contact you in an emergency.
Your answer
Grade *
Required
Estimated # of Students *
Your answer
# of Teachers *
Your answer
# of Aides *
Your answer
Does your class have any special needs? *
Your answer
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