Request an After School Program

Thank you for choosing Schlitz Audubon for your after school programming!

A teacher or school staff member must be present to assist and supervise during the program.

Our Registrar will be in touch with you within 2-3 business days of receiving your request.

Today's Date*
MM slash DD slash YYYY
Program Requested*
Grade*
Total Number of Students (Please see program maximums)*
School Name*
School District*
School Address*
City*
State*
Zip*
EMAIL ADDRESS TO RECEIVE INVOICE (Invoice will NOT be mailed, will only be delivered via email unless otherwise requested)*
Lead Teacher Attending Program*
Teacher(s) Email Address*
Teacher's Cell Phone*
Teacher's School Phone*
Person Completing Form (if different from teacher listed above)
Email Address of Person Completing Form
Phone of Person Completing Form
Preferred Date
MM slash DD slash YYYY
How did you hear about us?
Comments
Name
This field is for validation purposes and should be left unchanged.