Rowan Wild Education Programs Reservation Form

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 at either brooke.wilson@rowancountync.gov or misty.parrish@rowancountync.gov.

   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 at either brooke.wilson@rowancountync.gov or misty.parrish@rowancountync.gov.

7. Contact Name:*

9. Organization Name:*

10. Organization Type:
    -- Select One --SchoolHomeschoolClubScoutsOther

12. Contact Email: *

13. Contact Phone Number:*

14. County of Residence:*

18. **Please note that we are not scheduling on-site or outreach programs at the present.

20. Program Format:*

    1. Virtual

    1. On-site

    1. Outreach

22. 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

23. List of Virtual Programs
    Virtual Programs

25. 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

26. List of On-site Programs
    On-site Programs

28. Desired Program (Outreach):
    -- Select One --Animal ProgramOwl Pellet DissectionPoisonous Plants & Venomous AnimalsWorking WildHow do you Zoo?Skulls & Skins

29. List of Outreach Programs
    Outreach Programs

31. Are you able to use zoom software to engage in virtual programming?

    1. yes
    2. no

33. Number of Participants:*

    **Please refer to the program list above for individual program minimums**

34. Participant Grade Levels:*

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

    1. Middle School
    2. High School
    3. Adult

36. Please indicate your preferred date and time below, as well as two alternate dates and times.

    Please indicate your preferred date and time below, as well as two alternate dates and times.

38. **Program times must be between 10 a.m. and 2 p.m.**

    **Program times must be between 10 a.m. and 2 p.m.**

40. Preferred Program Date & Time:*
    Preferred Program Date & Time:

    Preferred Program Date & Time:

41. Alternate Date & Time 1:*
    Alternate Date & Time 1:

    Alternate Date & Time 1:

42. Alternate Date & Time 2:*
    Alternate Date & Time 2:

    Alternate Date & Time 2:

Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field