CREEK Program Registration Form Summer 2019
To request a CREEK Program date, please read our Policies & Procedures and complete this form. You will be contacted within one week to confirm schedule and payment options.

For Policies & Procedures, visit https://www.catawbariverkeeper.org/education/creek-program/

For more information, call 704-679-9494.

Organization/Group Name *
Your answer
Organization/Group Address *
Your answer
Organization/Group Phone Number *
Your answer
Coordinator Name *
Your answer
Coordinator Email *
Your answer
Coordinator Phone Number *
Please provide us with a number in which we will be able to reach you on the morning of the scheduled trip.
Your answer
Select Desired Program Option *
Select Desired Location *
Landsford Canal State Park (2051 Park Dr., Catawba, SC 29704), Tailrace Marina (1000 Marina Village Dr., Mt Holly, NC 28120)
Desired Date *
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Alternate Date
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Alternate Date
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Desired Start Time *
Depending on the size of your group, our program typically runs around 3 hours, including restroom and snack breaks.
Total Number of Students *
Minimum number 10; Maximum number 30
Your answer
Student Age Range *
Students must be between the ages of 11 - 17.
Your answer
Total Number of Chaperones *
Minimum 1 chaperone for every 10 students
Your answer
Please provide any additional student information we should be aware of (outdoor allergies, medical and/or behavioral conditions, etc.):
Your answer
Has your organization participated in the CREEK Program in the past? *
If yes, please enter the most recent date your organization participated.
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Please confirm that you have read the CREEK Program Policies & Procedures: *
Required
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