3. 

5. Please fill in all of the information requested below. Incomplete forms may result in a delay in scheduling. Once your form is submitted, you should be redirected to a confirmation page. This confirmation does not mean that your program is scheduled. You should receive an email from one of our staff members within 3 business days to confirm the scheduling of your program. If you do not receive a scheduling confirmation within 3 business days feel free to contact our education team by either emailing Misty Parrish or calling 704-216-7834.

7. Contact Name:*
9. Organization Name:*
10. Organization Type:
    -- Select One --SchoolHomeschoolClubScoutsOther
12. Contact Email: *
13. Contact Phone Number:*
14. County of Residence:*
18. Program Format:*

    1. Virtual

    1. On-site

    1. Outreach
20. Desired Program (Virtual):
    -- Select One --Animal ProgramPoisonous Plants & Venomous AnimalsSkulls and SkinsWorking WildHow do you Zoo?Black BearsRed WolvesWhite-tailed DeerRaptors of North CarolinaSnakes of North CarolinaTurtles of North Carolina
21. List of Virtual Programs
    Virtual Programs
23. Desired Program (On-site):
    -- Select One --Animal ProgramTrail Walk (Persimmon Branch @ Dan Nicholas)Trail Walk (Dunn's Mountain)Trail Walk (Eagle Point)Nature WalkOwl Pellet DissectionPoisonous Plants & Venomous AnimalsNature JournalingSkulls & SkinsWorking WildHow do you Zoo?Box Turtle Connection ProjectOutdoor SkillsHook, Line, and SinkerMacro-invertebrate DetectivesWalter Quality AssessmentBlack BearsRed Wold RecoveryWhite-tailed DeerRaptors of North CarolinaSnakes of North CarolinaTurtles of North Carolina
24. List of On-site Programs
    On-site Programs
26. Desired Program (Outreach):
    -- Select One --Animal ProgramOwl Pellet DissectionPoisonous Plants & Venomous AnimalsWorking WildHow do you Zoo?Skulls & Skins
27. List of Outreach Programs
    Outreach Programs
29. Are you able to use zoom software to engage in virtual programming?

    1. yes
    2. no
31. Number of Participants:*
    **Please refer to the program list above for individual program minimums**
32. Participant Grade Levels:*

    1. Preschool
    2. Kindergarten
    3. 1st-3rd Grade
    4. 4th-5th Grade

    1. Middle School
    2. High School
    3. Adult
34. Please indicate your preferred date and time below, as well as two alternate dates and times.
36. **Program times must be between 10 a.m. and 2 p.m.**
38. Preferred Program Date & Time:*
    Preferred Program Date & Time:

    Preferred Program Date & Time:
39. Alternate Date & Time 1:*
    Alternate Date & Time 1:

    Alternate Date & Time 1:
40. Alternate Date & Time 2:*
    Alternate Date & Time 2:

    Alternate Date & Time 2:
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field