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
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
Email address
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
Special Accommodations
Your answer
How did you learn of our Center?
Your answer
Comments
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