Wild Encounters Program Request Form John Ball Zoo Education Department, 1300 W. Fulton, Grand Rapids, MI 49504 Phone: 616-336-4301 ● Fax: 616-336-3907 ● Email: education@jbzoo.org Please complete this form and return it to JBZ Education Department via the email, fax or mailing address above. You will be contacted via email or phone to discuss your request. A confirmation will be sent by mail once registration is finalized. If you have any questions, concerns or special issues, please do not hesitate to call us at (616) 336-4301. Pick a Date Please give at least 3 possible dates and times for ease of scheduling. Programs may start as early as 9am. 1. 2. 3. Program Description Our 30-45 minute Wild Encounters classes are designed to teach students about one of our core education topics through a hands-on animal encounter in a classroom setting. These programs are available for groups of students of all ages up to 30 students (preschool classes are limited to 20 students). Siblings 3 years and younger are not allowed in the presentation. Program Cost $30.00 program fee/class for up to 30 students, teacher and 6 chaperones (preschool classes are limited to 20 students). Program fee does not include admission into the zoo. The discounted admission rate for schools groups is $3.00 per student. The teacher and one chaperone per five paid students are free. Additional chaperones and siblings are responsible for the admission price on the day of your program. Program fees are valid through October 30, 2015. Choose a Topic for Your Program (For a description of these topics, please visit our website at http://www.jbzoo.org/education/coretopics) Animal Presentations - Please select one of the following topics for you Wild Encounter. Custom programs may be available upon request. Preschool – K 1st- 3rd Grade 4th Grade and Above Body coverings Animal Classification Animal Adaptations Michigan Wildlife Growing up Wild Predator-Prey Animal Essentials/Needs Habitats Connections Animal Senses Endangered Species/Conservation Tell Us More About Your Group To help us provide you with a better program, please answer the following questions: 1. Why are you bringing your students to the zoo? 2. What are you studying in school that relates to your zoo visit and the topic you’ve chosen? 3. Do any of the students in your group have any needs we should be aware of? Time you plan on arriving at the Zoo: Time you must depart from the Zoo: Grade Level(s): Approx. # of classes coming: Approx. # of Students per class: Name of School: Name of primary contact person organizing the zoo visit: Email: Phone #: Fax #: School Mailing Address: City: Zip Code: Will you be traveling by bus or car? Additional Comments: John Ball Zoo Education Revised 07/17/15 www.jbzoo.org