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: