York County Water Education Program Sign Up Sheet

Water Education Program Sign Up Sheet

Please fill out the following form. The Environmental Coordinator will contact you shortly
Teacher Name
Email Address
Phone Number
School Name
Grade
Number of Students
Title of Class (MS or HS)
Dates and Times: (At least two weeks in advance)
1st Choice Date
1st Choice Time
2nd Choice Date
2nd Choice Time
3rd Choice Date
3rd Choice Time
If participating in an outdoor class, do you have a creek, stream, or river location in mind?	Yes No
If yes what location
Please send me more information about:	Adopt-a-stream River of Words & Art Contest World Water Monitoring Day
Please tell us how you heard about our Water education program:	EEL Email TYLER Website Word of Mouth Other
If other where?
May we invite the media to cover your student's particpation in this program?	Yes No