Request A ZOOmobile Program

ZOOmobile Request Form

To request a ZOOmobile program, please fill out the information below. Once this form is submitted, the Outreach Administrator will review the form and contact you to complete your request. Your ZOOmobile program is not finalized until you are contacted by the Outreach Administrator.

* Indicates required information.

CONTACT INFORMATION

First Name*

Last 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). We recommend submitting your request at least 8 weeks in advance because availability is limited and our calendar fills up quickly. We are able to schedule up to a year in advance, and contacting us early will help to ensure that we find a date that works.

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.*

 30-Minute ZOOmobile program (for preschool and Kindergarten age audiences – up to 35 children) School year (9/1/16 – 6/16/17): $160 plus travel fee if applicable Summer (6/17/17 – 8/27/17): $175 plus travel fee if applicable
 50-minute ZOOmobile program (for elementary, middle, or high school age audiences – up to 100 participants) School year (9/1/16 – 6/16/17): $230 plus travel fee if applicable Summer (6/17/17 – 8/27/17): $250 plus travel fee if applicable
 50-minute ZOOmobile program (for adults – up to 100 participants) School year (9/1/16 – 6/16/17): $230 plus travel fee if applicable Summer (6/17/17 – 8/27/17): $250 plus travel fee 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?

Additional comments/special requests

Please leave this field empty.

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

Please note: Submitting this form does not guarantee a ZOOmobile program during the date and time you request. Your ZOOmobile reservation is not finalized until you have received a confirmation from the Outreach Administrator. We recommend submitting a request at least 8 weeks in advance because availability is limited and our calendar fills up quickly.