Program Request

Program Request
Program requests are tentative until confirmed by an Education Manager. Please allow up to 10 days from the time of your submission for an education staff member to contact you. In your submission, provide up to three potential dates for your program. When selecting a location, identify your preferred Great Parks destination or select "Other Location" if requesting an off-site program.
Submitter Name*

First NameLast Name
Submitter Email*
Group Name*
Contact Person (day of program)*
Contact Phone Number*

Area CodePhone Number
Contact Email*
Group Size*
Age Range*
First Preferred Program Date & Time*
MM/DD/YYYY 12:34 p.m.
Second Preferred Program Date & Time
MM/DD/YYYY 12:34 p.m.
Third Preferred Program Date & Time
MM/DD/YYYY 12:34 p.m.
Program Held At*

Great Parks DestinationOther Location
Preferred Great Parks Destination*

Embshoff Woods Nature PreserveFarbach-Werner Nature PreserveFernbank ParkGlenwood GardensLake IsabellaMiami Whitewater ForestMitchell Memorial ForestParky's FarmSharon WoodsShawnee LookoutWinton WoodsWoodland Mound
If not a Great Parks destination, provide details here.
Program Theme or Title*
Should be Empty: