Fox Theater’s “Around the Americas” Performance – Zoo To You Outreach Request Form Outreach Program Request Form (Fox Theater) Please fill out the following form to request a Zoo to You Outreach program at your facility. 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 this where the Outreach Program will take place?*YesNoAre you a Title 1 School?*NoYesLimited funding may be available to cover the cost of this program.Fox Theater Performance* I am attending the Fox Theater's "Around the Americas" performance with my class.Will the program take place indoors or outdoors?*IndoorsOutdoors (temperature dependent)Outreach Program Location* 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 First date choice*Second date choiceThird date choiceDesired start time*How many people will participate in the program? (more than 40 may require additional programs)*What is the age range of the participants?* PreSchool Kindergarten Grades 1-2 Grade 3 Additional questions or notes for Zoo staff?
