Yaquina Head: Spring 2018 Registration Form - U.s. Department Of The Interior

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Yaquina Head: Spring 2018 Registration Form
1. Please fill in your top 4 choices with slot dates and times using the program calendar:
Max. 35 students per TP or LH Slot
First Choice:
M T W Th F
Date__________
Slot(s) _________
Times _______________________
Second Choice: M T W Th F
Date__________
Slot(s) _________
Times _______________________
Third Choice:
M T W Th F
Date__________
Slot(s) _________
Times _______________________
Fourth Choice: M T W Th F
Date__________
Slot(s) _________
Times _______________________
2. Please SELECT the program(s) you would like:
RANGER-LED PROGRAMS
rd
Tidepool School: K - 3
Grade. Same program, new name!
th
th
Sea-Crets of Tide Pools: 4
- 5
Grade
th
th
Wealthy Tide Pools: 6
- 8
Grade
Wealthy Tide Pools: High School
rd
th
Lighthouse Program: 3
- 5
Grade
TEACHER-LED PROGRAMS (Any Grade Level)
Tide Pool Exploration (Use your own activities and lesson plans)
Interpretive Center Visit (May be in addition to other programs)
3. Students and Chaperones
Student Grade Level(s): ___________
Number of Students: ______________
Number of Adult Chaperones: ______________ (1 chaperone per 5 students)
Type of Vehicle(s): ________________________
Number of Vehicles: ___________________________________
4. Please fill in your contact information:
School Name: ________________________________________________________________________________________
School Address: ______________________________________________________________________________________
________________________________________________________________________
Name of Teacher or Trip Coordinator: _____________________________________________________________________
Teacher’s E-Mail Address: ______________________________________________________________________________
Your Phone Number at Work: (
) _________________________________________________________________
Cell Number:
(
) ____________________________________________________________________________
Best time during the school day to reach you a week before your trip: _____________________________________________
Are you staying in Newport the night before your Yaquina Head class? No / Yes at _________________________________
Special considerations / Notes:
_____________________________________________________________________________________________________
* * * FOR STAFF USE * * * * * * * * * * * * * * * * * * * * * * * * *
Received: date/time_________________________________________________________________by_______________
Date/Slot Confirmed _______________________________
Pre/Post Emailed: ________________________________

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