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Name *

First Name

Last Name

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Phone *

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Email Address *

Requested Program

Please complete a different request for each program.

Contract/Agreement type *

Independent parent or parent group

School/organization contract paid by the school

School/organization contract paid per child by parents

School/organization contract paid by a parent group

Other (describe below)

Not sure at this time

Name of your school, organization, or group *

Program Site Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Desired start date of program *

Interested in programming on this/these day/s *

Check all that apply.

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Weekdays only

Weekends only

Any day

Interested in programming for the *

Check all that apply

mornings (9am-noon)

lunch time/early afternoon

after school (4pm-6pm)

evenings (7pm-9pm)

Desired length of program *

It's okay to give an estimate.

Single session

2-3 sessions

4-8 weeks

9-20 weeks

21-40 weeks

not sure at this time

Frequency of sessions *

one-time event/program

once a week

twice a week

3+ times a week

once a month

twice a month

3+ times a month

quarterly

other

Tell us a little more about your group *

Ages/grades, number of participants, specific needs/considerations when programming for your group

Thank you! We’ll get started with your customized proposal and get back to you with 48 hours.

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