A Day in the Dirt School Registration Form

A Day in the Dirt School Registration Form

Please complete and submit ASAP. Registration deadline is Friday April 2, 2026... If you have any questions, please call Rachel at 409-384-5335 or email info@jc3texas.com.
Classroom/School GroupGroup Home/Nursing Home/Therapy Groups (Skip to Section B)Homeschool/Individual (Skip to Section C)
SECTION A: FOR SCHOOLS ONLY
School ISD
Campus Name
I.e. Elementary, Junior High, High School
Contact Teacher Name

First NameLast Name
Additional Teacher Name (optional)

First NameLast Name
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional Contact Phone Number (optional)
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email Address
example@example.com
We will have "Student Aides" available to walk with your class during the entire event. These Aides will help you and your class with any assistance you require. If you will need a Student Aide(s), please indicate how many you are requesting below. If you do not need any, please indicate "0"
Please fill out the chart below. Please try to fill out ALL fields accordingly. If additional spaces are need, please submit an additional form.

SECTION B: FOR GROUP HOMES/NURSING HOMES/THERAPY GROUPS
Facility Name
Facility City
Contact Name

First NameLast Name
Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email
example@example.com
We will have "Student Aides" available to walk with your group during the entire event. These Aides will help you and your group with any assistance you require. If you will need a Student Aide(s), please indicate how many you are requesting below. If you do not need any, please indicate "0"

SECTION A: FOR SCHOOLS ONLY