Rowan Wild Education Programs Reservation Form

3. 

5. <p align="center" style="font-size:18px; color:darkblue"> 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 <b>DOES NOT</b> 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. </p>

   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. <p align="center">Please indicate your preferred date and time below, as well as two alternate dates and times. <b><font color="red">**Program times must be between 10 a.m. and 2 p.m.**</b></font></p>

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