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*
Date Format: 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
Date Format: MM slash DD slash YYYY
How did you hear about us?
Comments
Phone
This field is for validation purposes and should be left unchanged.