Virtual Field Trips: Summer 2020 Registration Form
Please fill out the information below with as much information as you have available. If you would prefer to have information sent to you via the post, please indicate so in the comments section. Email reservations@wagnerfreeinstitute.org with any questions.
Contact Name
*
Prefix
First Name
Last Name
E-mail
*
Cell Phone Number
*
-
Area Code
Phone Number
Organization (if applicable)
Zipcode
*
Number of Children
*
Name(s) of Child(ren)
*
Number of Devices You Would Use to Connect
*
Age or Age Range
*
Available Day of the Week
*
Tuesday
Thursday
Available Time of the Day
*
11am-12pm
4pm-5pm
Other
Preferred Date(s)
*
Additional Comments
Please provide details if any group members have special needs or require special assistance so that we can be prepared for your visit or any other concerns/questions.
*
We will use your cell phone number to confirm your reservation the morning of the program.
Submit Form
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