GRANT FUNDED STEM/STEAM/MONITOR THE WICHITA RESERVATION REQUEST FORM

Please fill out the form below. A confirmation email will be sent to you noting the time and date of your reservation based on your choices below and current availability. Keep in mind your reservation will not be confirmed until you get a confirmation email. For more information contact us at 940-767-0843 or email info@riverbendnaturecenter.org.
Select Program Below*
Organization or School Name*
Organization Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
First Last
Contact Phone*
Contact Email*
Age Range of Students*
Grade Level of Students*
Number of Students (not to exceed 40 children per program)*
Number of Adults*
Additional Notes
Please select your first, second, and third choice for your field trip. Dates and times will be filled on a first come first served basis.
First Choice*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Second Choice*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Third Choice*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Total number of chaperones required (N/A for adult groups): 1 Adult per 10 Children (One chaperone is required to accompany each field guide. Please bring one chaperone/10 students)
A few reminders to make your visit the best!
1. Please wear comfortable, close-toed, sturdy shoes.
2. Be observant of the weather conditions and dress appropriately.
3. Place a name tag on each child.
4. Divide your class/group into groups of 10.
Please communicate the above information to any other teachers or chaperones that will be accompanying your group.
In the event of inclement weather, the decision to cancel will be yours. Please call on or before 7:00 a.m. the morning of your tour if you are canceling and leave a message.
If you have any questions, please call Leslie Fernandes 767-0843. By signing below you agree to follow the above procedures.
Name
First Last
Date
MM slash DD slash YYYY
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