ZOOmobile Request

The Maryland Zoo in Baltimore has received a grant to deliver our ZOOmobile program free to 2nd grade students at select Title I schools.
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.
Available time slots fill up fast, so please submit your request as soon as possible. We ask that all requests be submitted by November 21, 2012.

* Indicates required information.

CONTACT INFORMATION

Your Name*

Facility Name*

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, 50 minute program ends at 10:50am). Please note ZOOmobile times fill up fast. Availability is limited. We recommend submitting a request at least 4 weeks in advance of your requested date. We are only able to offer this program between September 1, 2012, and February 28, 2013.

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

Please select your program of choice from the list below.

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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 info about our Raven Partner Package, click here.
I am interested in the Raven Partner Package.