Class/Workshop Request Form

Group/Organization Name*

Contact Person Name*

First Last

Contact's Phone Number*

Contact's email*

Contact/Organization's Address

Street Address City State ZIP Code

Choose program type*

All programs take place at Niabi Zoo

Please choose program length*

Program Date - 1st choice (MM/DD/YYYY)*

Program Date - 2nd choice (MM/DD/YYYY)*

Program START time (Between 9:30am-2pm)*

Program Topic*

If there is a specific topic you would like covered, please describe. Otherwise, type Zoo

Total Number of Participants*

Include those that will actively participate.

Total Number of Chaperones/Supervisors

If applicable, include those that will be present (may or may not participate)

Participant Age Range*

Please select all that apply

Spam Prevention