Schedule a Visit

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Request Type:
Zip Code:*
City:*
County:*
State:*
School District:
Name of School:*
Name of Fair:*
Name of Event:*
Physical Address:*
Please enter the
entire address.
Mailing Address:
Phone Number:*
Fax Number:*
Contact Person:*
Contact Email:*
Secondary Email:
Please fill this field out due to school email security.
Contact Position:*
After-hours
Emergency Phone #:

Please indicate a Start and End date.

Event Start Date.* Click for Calendar Click on calendar icon to select date.
Event End Date.* Click for Calendar Click on calendar icon to select date.

Please indicate four choices of dates that will work.

1.* Click for Calendar Click on calendar icon to select date.
2.* Click for Calendar Click on calendar icon to select date.
3.* Click for Calendar Click on calendar icon to select date.
4.* Click for Calendar Click on calendar icon to select date.

We will try our best to accommodate you on one of these dates.
Starting Time for Presentation:*

Enrollment Data*

All fields marked with * are required if you do not know the # of students or # of classes enter 0.

Grade
# of Students
# of Classes
K*
1st*
2nd*
3rd*
4th*
5th*
6th*
7th*
8th*
9th*
10th*
11th*
12th*
Expected Attendance:*
Expected Attendance:*
Expected General Public Attendance:*
Expected Scheduled Children Attendance:*
* I understand the physical requirements for the 36 foot Classroom and will be able to provide the necessary arrangements for accommodations.
* I further understand that the Mobile Dairy Classroom is an educational program and agree to instruct the students and faculty that excellent behavior is expected.
Name of Principal:*
Security Code: