Mission Scheduling Form
Please complete this form to schedule your mission with the Challenger Learning Center of Lake Erie West. You will receive a confirmation email confirming your mission details from one of our staff within five business days after the form is submitted. Questions can be directed to 419-725-5926 or challengerlc@esclakeeriewest.org
Email address *
Contact Person *
Your answer
Teacher/Leader for Mission Day *
Your answer
School or Organization *
Your answer
Mailing Address Street *
Your answer
Mailing Address City, State, Zip Code *
Your answer
Billing Address *
Your answer
Phone Number *
Your answer
Alternate Phone Number (Specify cell or other)
Your answer
Emergency Contact and Phone Number *
Your answer
Mission *
Has teacher attended teacher training program? *
Top Gun Teacher? *
Number of years attended? *
Your answer
Is this mission approved by your administrator? *
Mission Date (If a mission is already scheduled for your desired date, you will be contacted to select another date) *
MM
/
DD
/
YYYY
Mission Time Preference *
Number of Students *
Your answer
Number of Adults *
Your answer
Grade Level(s) *
Required
Additional Programs *
Required
Will the students be eating lunch at the Center *
Special Accommodations
Your answer
How did you learn of our Center? *
Your answer
Comments
Your answer
A copy of your responses will be emailed to the address you provided.
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