School Name:

Teacher Contact 1:

Teacher Contact 2:

School Address:

City:   State: Zip Code:

Phone & fax 1: Phone & fax 2:

Email 1:

Email 2:

Best Time to Contact Teacher 1: Teacher 2:

Grade(s) Participating:

Number of Students:  Number of Adults:

Any special student needs? (Gifted students, students with mobility, hearing, sight, or learning impairments; students who may have allergic reactions to outdoor environments such as hay, tobacco, wood smoke, etc. If yes, please elaborate:

PAC Program Requested:

Select One Cannon Drill – 60 minutes The River Runs Through It - 60 minutes A Surrender Most Disgraceful – 60 From Slavery to Freedom- 60 Min Soldier Drill – 60 minutes Select One Cannon Drill – 60 minutes The River Runs Through It - 60 minutes A Surrender Most Disgraceful – 60 From Slavery to Freedom- 60 Min Soldier Drill – 60 minutes

Program Date(s) First Choice:  Dates Available

Second Choice:

Program Time: Select One 9:00 a.m. 11:00 a.m. Estimated Arrival Time: