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North County School Outreach Request Form
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1.
Question - Required -
Teacher Name
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2.
Question - Required -
Email Address
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3.
Question - Required -
School Name
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4.
Question - Required -
Grade Level
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5.
Question - Required -
Approximate Number of Students per Class
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6.
Question - Required -
School Zip Code
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7.
Question - Required -
Is your school Title 1?
Please select response
Yes
No
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8.
Question - Required -
Please select which lesson you would like to receive from the topics below:
Please select response
Dog Safety: Meeting and Interacting Safely with Dogs
Pet Care: What Our Pets Need to be Healthy, Happy, and Safe
Animal Shelters: Helping Pets and People with Pets
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9.
Question - Required -
Please list all of the classes (including your own) you would like us to visit. Include each teacher's name, room number, and email address.
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10.
Question - Required -
Please list in order of preference 2-3 days of the week that work best for you and your preferred start time on those days (ex. Tuesdays at 9:30am).
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11.
Question - Required -
Please list school start and end times to assist with scheduling.
(Maximum response 255 chars, approx. 5 rows of text)
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12.
Question - Required -
Please list recess and lunch times to assist with scheduling.
(Maximum response 255 chars, approx. 5 rows of text)
13.
Question - Not Required -
Please share any additional comments or questions you may have or any helpful information regarding scheduling.
14.
Question - Not Required -
Please provide any special instructions regarding parking if needed.
(Maximum response 255 chars, approx. 5 rows of text)
Spam Control Text:
Please leave this field empty
