Schedule A Program

ZOOmobile Request Form

Before completing this request, please review our suggestions for how to prepare for our ZOOmobile visit. To request a ZOOmobile program, please fill out the information below. Once this form is submitted, the Education Programs Administrator will review the form and contact you to complete your request. Your ZOOmobile program is not finalized until you are contacted by the Education Programs Administrator.

* Indicates required information.

CONTACT INFORMATION

Your Name*

Facility Name*

Facilty Type*

Address*

City*

State*

Zip Code*

County*

Phone Number*

Fax Number

Email*

Best Time to Reach You*

PROGRAM INFORMATION

Please select your top three dates and times for the ZOOmobile visit. Also, select a start time for each (For example: 10:00am start time, 30 minute program ends at 10:30am). Please note ZOOmobile times fill up fast. Availability is limited. We recommend submitting a request 6-8 weeks in advance of your requested date.

Requested Date of Program(s) 1st choice (MM/DD/YY)*

Time 1*

Requested Date of Program(s) 2nd choice (MM/DD/YY)

Time 2

Requested Date of Program(s) 3rd choice (MM/DD/YY)

Time 3

SELECT PROGRAM(S)

How many programs are your requesting?*

How many people will there be in each audience?*

How old will each audience be?*

Please select the program(s) you are interested in. Please note that 30 minute programs have a maximum audience size of 35 participants and 50 minute programs have a maximum audience size of 100 participants.*

Daycare, Preschool or Kindergarten program (ages 2-5) Up to 35 participants, 30 minutes, $150 per program (plus travel if applicable)
School-age Program (ages 6-12) Up to 100 participants, 50 minutes, $220 per program (plus travel if applicable)
Adult Program (ages 13 and above) Up to 100 participants, 50 minutes, $220 per program (plus travel if applicable)

Please select your first program of choice from the list below.

How many of your first program choice would you like to request?

Please select your second program of choice from the list below.

How many of your second program choice would you like to request?

For more information about each program click here.

Additional comments/special requests

Be sure to check out our Penguin Partner Package! For an additional fee of $150, you can become a Penguin Partner. For more information about our Penguin Partner Package click here.
I am interested in the Penguin Partner Package.

Also, be sure to check out our new Raven Partner Package! For an additional $100, you can become a Raven Partner! For more information about our Raven Partner Package click here.
I am interested in the Raven Partner Package