School Program Registration Form

School Name *

Contact Person/Teacher *

Email Address *

Address

City

Province

Postal Code

Phone Number (Day) *

Phone Number (Evening)

Grade Level

Class Size

Are you interested in booking a(n) *

Field Trip

Outreach Program

Field trips and outreach programs run from 1.5-2 hours in duration. What time works best for you?

Morning

Afternoon

Please provide us with 2 booking options for your field trip/outreach program in order of preference. *

First Option

Second Option

What program(s) are you interested in registering for? Please refer to our school program brochure available at www.portcoquitlam.ca/leighsquare.

Do you have children in your class with special/medical needs? Are these children accompanied by an SEA? Please list any applicable circumstances below to help us adequately meet the needs of your class.

Do you have any special requests for your field trip/outreach program? All programs can be tailored to class needs.

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