Wings of Wonder Outreach Request Form

Ameritas Wings of Wonder Outreach Request Form
The Bird Experience Team is bringing their feathered friends to you! These traveling encounters are great for all ages, organizations and events including scouts, schools, retirement homes and special events!

Choose between two programs, a penguin meet and greet or a chance to meet the stars of the Wings of Wonder! In these experiences, you’ll gain a greater respect for birds and wildlife, learn about the bird’s natural history, their personal stories and see natural behaviors including flying!
- Filling out this form does not guarantee we can accommodate your request. A member of our team will reach out within a week to confirm final details and accept payment.
- These programs run October 20-December 29, 2025 and March 2-April 13, 2026.
- Programs are for ages Kindergarten-Adult
- Payment is due 2 weeks in advance of your first program date.
  - Payments accepted: check, credit card, purchase order.
See our Wings of Wonder Outreach Program webpage for program specifics.

Sponsored by:

Group Information
Group Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Phone Number*
Please enter a valid phone number.
Group Type*
If other, explain.
Contact Information
Name*

First NameLast Name
Contact Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Is this the same Day Of program contact?*

YesNo
Day of Contact Name

First NameLast Name
Day of Phone Number
Please enter a valid phone number.
Day of Contact Email
example@example.com

Program Details
How many programs total do you want?
Program Reminders

Number of Programs per day
- Birds of a Feather- 3 programs per day
- Penguin Pals - 2 programs per day
Program Length
- Birds of a Feather- 45 minutes
- Penguin Pals - 30 minutes
Maximum Participants per programs
- Birds of a Feather- 75 people
- Penguin Pals - 50 people

Preferred Topics, Dates, and Times

	Topic	1st Choice Date	2nd Choice Date	Time	Participants	Age/Grade Range (K-Adult)
Program 1
Program 2
Program 3
Program 4

Preferred Topics, Dates, and Times

	Topic	1st Choice Date	2nd Choice Date	Time	Participants	Age/Grade Range (K-Adult)
Program 5
Programs 6
Program 7
Program 8
Program 9
Program 10

Are your dates/times flexible?*

YesNo
About Your Group
Please list any special needs/accommodations for your group.*
Please list any nut or fruit allergies, or other needs/accomodations, or other important information.
Will there be a service animal or other animals present in the program room?*

YesNo
What type of animal will be present?
ie a service dog for cardiac alert, classroom rabbit, office cat.