Animal Outreach Request

Request Form

THIS FORM SERVES AS A REQUEST TO SCHEDULE AN ANIMAL OUTREACH FROM THE GREENSBORO SCIENCE CENTER. THIS IS NOT A RESERVATION UNTIL YOU RECEIVE A CONFIRMATION EMAIL FROM OUR EDUCATION DEPARTMENT.

Requests are processed in the order they are received. If you do not hear from us within 2-3 business days of your submission, email jgouge@greensboroscience.org or call (336) 288-3769 ext. 1315.

Our animal outreach program is offered summer (June-August) weekday mornings Tuesday-Friday only. Cost is $100 for up to 45 minutes with 3 animals.

- Children must be age 3 years and up.
- The group must be no larger than 60 in number.
- The site must be indoors in a space with no other animals, including classroom pets.

- Sites must be within a 35 mile radius of the Greensboro Science Center.

Round trip mileage will be charged at the IRS business standard mileage rate as calculated from Google Maps.

Question Title

* 1. School or Organization Information

Name of Contact Person *

Company or Organization Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address of Contact Person *

Phone Number of Contact Person *

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* 2. Company or Organization Phone Number

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* 3. What type of group are you?

Public or Private School (Pre-k - 12th)

College or University

Child Care or Daycare etc.

Youth groups, Summer Camps, YMCAs, Scouts, ACES/After School etc.

Adult group, Church, Friends and Families, Senior Center, etc.

Homeschool

Other (please specify)

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* 4. How many programs are you requesting on this date?

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* 5. Please provide your first choice of date for your Animal Outreach program. Please remember, programs are only available Tuesday - Friday.

Date

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* 6. Please provide your second choice of date for your Animal Outreach program. Please remember, programs are only available Tuesday - Friday.

Date

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* 7. Please provide your third choice of date for your Animal Outreach program. Please remember, programs are only available Tuesday - Friday.

Date