*School / Group Name

*Date of Visit
January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2011 2012 2013

*Day of Week
Monday Tuesday Wednesday Thursday Friday

*Arrival Time & Departure Time
9:00AM 9:30AM 10:00AM 10:30AM 11:00AM 11:30AM 12:00PM 12:30PM 1:00PM 1:30PM 2:00PM 2:30PM 3:00PM 3:30PM 4:00PM 4:30PM 5:00PM to 9:00AM 9:30AM 10:00AM 10:30AM 11:00AM 11:30AM 12:00PM 12:30PM 1:00PM 1:30PM 2:00PM 2:30PM 3:00PM 3:30PM 4:00PM 4:30PM 5:00PM

*Ages and/or Description

*Expected Number of Children

*Expected Number of Adult Chaperones

*Will you be bringing lunches?
No Yes

*Which activities will you be using?
Hudson Explorer Packs. Select one.
Secret Spaces
Frog Hunt
Woodland Wonders
Pollination Investigation
Making Sense
Leaf Lookout

Additional Self-guided Activities. Select all that apply.
Scavenger Hunts
Pollinator Bingo
Fascinating Frogs
Pumpkin Patch
Name That Needle

*Contact Person's Name

*Contact Person's Title or Role

*Daytime Phone Number

Alternative Phone Number

*Email Address

*Fax Number

*Mailing Address

*City

*State
Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Flordia Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zip Code

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