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2021 Summer Excursion Request Form
If you do not hear from our Education Coordinator within two weeks of filling out this form, please let us know by calling 920-448-5150 x 201 or emailing
edassistant@heritagehillgb.org
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* Indicates required question
Email
*
Your email
School or Organization Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Teacher (Contact Person)
*
Your answer
School/Organization Phone Number
*
Your answer
Emergency Contact Number (Cell phone only used in case of emergency)
*
Your answer
Ages
*
3-5
6-8
9-12
Required
Estimated # of Students
*
Your answer
Estimated # of Teachers
*
Your answer
Estimated # of Aides
*
Your answer
Estimated # of Additional Chaperones (1 free chaperone per 15 students)
*
Your answer
Does your class have special needs?
*
Your answer
Does your class have English language learners?
*
Your answer
Are you planning on eating lunch at the park?
*
Yes
No
Any additional comments or questions.
*
Your answer
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