VIRTUAL Zoo Adventure Program Request VIRTUAL Zoo Adventure Request Form Please fill out the following form to request a virtual, ONLINE Zoo Adventure program. THIS IS A REQUEST ONLY. Please call 520-837-8200 if you do not receive a response from the education team within 48 hours. Reservations must be made 2 weeks in advance of requested date. Please make sure you see a confirmation screen indicating your form has been submitted successfully. Today's Date* Date Format: MM slash DD slash YYYY Name* First Last Phone*Email* School or Organization NameOrganization Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your school a Title 1 school?NOYESPlease list your top two date choices (please use + to add dates)* Desired start time, programs must take place after 8:30am MST-AZ*Please select a time for your program. What TIME ZONE are you in?Program topicHabitatsAdaptationsZoo 101Locomotion (Grades K-2 only)Conservation and Endangered Species (Grades 3 and up)Animal Food and Nutrition (Grades 3 and up)Animal Health Care (Grades 3 and up)How many people will participate in the program?*Will some participants be joining us separately from their own home? YES No, we will all be watching together from one computer/tablet How many additional people will the link be given to so that they can watch from their own home?What is the age range of the participants?* PreSchool Kindergarten Grades 1-2 Grades 3-6 Grades 7-8 High School Adult group Virtual Program Safety a teacher or other adult responsible for the group MUST be present for the entire virtual program.By checking this box, I understand that a teacher or other adult responsible for the group MUST be present for the entire virtual program. Available Technology - please select an option for video AND audio Yes, I will have a webcam and can share my video during the program. No, I do not have a webcam. Yes, I can share audio through my computer, laptop or other microphone. No, I will not be able to share audio during the program. I do not have access to a computer, please contact me to discuss options Please assist us in planning for your program by checking which technological features will be available to you during your program. (Having a webcam and/or microphone is preferred to improve the interaction between educators and students but not required). What payment method do you plan to use to pay for your program?* Check Credit Card Purchase Order Payment or PO must be received before the program start date. Additional questions or notes for Zoo staff?CAPTCHACommentsThis field is for validation purposes and should be left unchanged.