Community Engagement Outreach Request

Contact Information

Organization Name

First name

Last name

Phone number

Program Location Address

Address 2

City

State

Zip code

Program Information

Program Type

Preferred Date and Time

Requests must be submitted at least 2 weeks prior to event.

Alternate Date and Time 1

Alternate Date and Time 2

Number of Groups/Classes

Total Expected Attendance

Number of Adults

Number of Children/Youth

Ages

All Ages Adults High School Age (9th-12th grades) Secondary School Age (5th-8th grades) Primary School Age (K-4th grades) 4 and under

Ages/Grades

Audience Description

Please provide a brief description of the audience

Would you like to request bilingual (Spanish-speaking) Zoo staff attend your event?

Yes No

Additional Information/Comments

Program Expectations

What outcomes do you wish to achieve through our time together?

Location Description

Is the event indoor or outdoor?

Indoor Outdoor

Is parking available?

Yes No

PLEASE CONFIRM*

I understand this is only a request and a program has not been scheduled.

Please note, we do not bring animals to community engagement outreach events.

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Community Engagement Outreach Request

Contact Information

Program Information

Program Expectations

Location Description