Mobile Classroom Request

ORGANIZATION

Name

PHYSICAL ADDRESS

Multi-line address

Country/Region

Address

City

Zip / Postal code

MAILING ADDRESS

Mailing address is the same as Physical Address

Multi-line address

Country/Region

Address

City

Zip / Postal code

First name

Last name

Phone

Numbers only. No Special characters or spaces

Best Time to Contact

Time

HoursMinutes

Preferred Method of Contact

You will be contacted to confirm the details of your request.

Grade Level

Elementary

Middle School

Program Type

Estimated Number of Students Participating

General Information:

Programming will run for two (2) hours, with an additional thirty (30) minutes on either side for set up and tear down.
Organization shall provide acceptable facilities on location for WorkshopMT’s programming
Each participant shall have a signed and submitted Participant Agreement before the first class.
Organization shall provide a minimum of one (1) additional adult as a Chaperone. The Chaperone shall be present at all times during WorkshopMT’s programming.

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