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Career Visit Request Form

Thank you for your interest in the Ariel Thee RDH Career Visit!
Please complete the following survey and we'll respond to your request as soon as possible.
Thank you!
1.Please Provide ALL information Requested for your Visit:
Please Include in your response:
1. Your Contact Information
   1.First & Last Name
   2.Your position at the school i.e. (student, instructor, principle etc.)
   3.Your Telephone #
   4.Your Email 
2. The School's Information 
    1.Name of the School 
    2.School Address 
    3.Phone Number 
    4.Website(Required.)
2.When is your Career Day?
**If not specific please list 3 dates of availability for Ariel Thee RDH to Visit(Required.)
3.What is the duration of time would you prefer for this visit?(Required.)
4.How many students are "scheduled" to attend the Ariel Thee RDH Career Visit?(Required.)
5.What are the grade levels of the students participating in the RDH Career Visit?
Check all that apply:(Required.)
6.What are 3 main questions Ariel Thee RDH can answer during the visit?(Required.)
7.What would the instructors/ students like to take away from this RDH Career Visit?(Required.)
8.Will Ariel be able to talk about her programs and products during the visit, and welcome the instructors/students to register, purchase or find more information via a link/website?(Required.)
9.Will Ariel Thee RDH Company be allowed to record live media (i.e pictures, audio videos etc.) during this Career Visit?
PLEASE READ BEFORE SELECTION
*If Yes, please note that Ariel Thee RDH Company is automatically granted the permissions to post this content on any platform of their choosing.

*If Yes, with minors, please note that Ariel Thee RDH Company should be informed prior to the RDH Career visit that ALL students were granted permission by the parent/guardian. If needed, a Media Release form can be emailed to the school's appointed instructor/ authority from Ariel Thee RDH Company prior to the visit. The media release will be sent to the appointed instructor/ authority to then be distributed to parents/ guardians to sign and grant permissions. Copies of EACH form should be then made for Ariel Thee RDH Company records. 
***It is the school's responsibility to make sure any minors that have not been granted permissions to participate in media be excluded from any pictures, video, or audio recording once granting overall access. Ariel Thee RDH Company is not responsible for any unwarranted media release.(Required.)
10.Does the school have a budget in place for a possible travel fee?
*Please note that Ariel Thee RDH Company does charge a travel fee dependent upon the total distance from Tooth Fairy Central Headquarters. 
ADDITIONAL TRAVEL FEES MAY BE ADDED TO YOUR SERVICE DEPENDANT UPON DISTANCE AND NECCESARY ACCOMEDATIONS (i.e. fuel, flights, hotels stays etc.). TRAVEL FEES  VARY  PER CONTRACT AND WILL BE CONFIRMED BEFORE THE FINAL CONTRACT IS SIGNED. 
(Required.)