Welcome to the Resource Conservation District of the Santa Monica Mountains

Please provide the following information for each program you wish to schedule. You may schedule up to three programs at one time. Number of groups may range from 1 to 5. Group size may range from about 9 to 15. At least one adult chaperon per group is requested. Adult chaperons add no charge to the program fee.

Program 1

Education Site: *

Date: *

Number of Students: *

Number of Groups: *

Grade Level(s): *

Number of Adult Chaperones: *

Program 2

Education Site:

Date:

Number of Students:

Number of Groups:

Grade Level(s):

Number of Adult Chaperones:

Program 3

Education Site:

Date:

Number of Students:

Number of Groups:

Grade Level(s):

Number of Adult Chaperones:

Teacher Contact Information

Provide the first and last name of the teacher who will be our contact on program day, the teacher's email and phone number (cell preferred), the complete address of the school or organization, and its phone and fax numbers.

First Name: *

Last Name: *

Phone Number (cell preferred): *

Email: *

Complete Address of School or Organization: *

School Phone: *

School Fax: *

School Type, School District and Mode of Transportation

Please indicate what type of school you belong to, what public school district it is in (even if the school is not public), and how you will travel to the program.

School Type: *

Other:

School District: *

Other:

Mode of transportation: *

Other:

Non-teacher Contact Information

If you're not the teacher, but coordinating on behalf of the teacher, provide your first and last name, your email and phone number. Also if you wish to receive the invoice at an address which is not the school's, then provide that address.

Scheduler is:

First Name:

Last Name:

Phone Number:

Email:

Invoice Address:

Program Notes

If applicable to your program, please use this space to indicate special needs, requests etc.

Notes:

Program Reservation Form