Third to Fifth Grade Online Interactive Learning Session Registration

Contact Info
Primary Contact Name*
First Last
Primary Contact Email*
Enter Email Confirm Email
Primary Contact Mobile Phone*
Are you a member?*
Name of adult in charge of students*
First Last
Mobile phone for adult in charge of students*
Email address for adult in charge of students*
Technology Information
What video conferencing platform does your district allow?*
Will this visit be with students in a classroom or with students at their homes?*
If on individual tablets, will the teacher have control of the tablets?*
School Group Information
School Name*
Address*
Street Address Address Line 2 City State ZIP Code
School Phone Number*
Classroom Phone Number*
School District (If Applicable)
What grade level?*
What kind of school are you from?*
- Public School
- Public School (Title I)
- Private School
- Faith-based School
- Home School
- Other
County
We welcome all to the Wildflower Center. Please let us know if any of your students have special needs.
Session Details
3-5 Online Interactive Learning Sessions are available Monday through Friday.
Select Desired Date*
MM slash DD slash YYYY
Select Alternate Date*
MM slash DD slash YYYY
Select Desired Time*
Select Alternate Time*
Choose One Session*
Note: If you would like multiple groups sessions, please submit a registration form for each group with a different time for each.
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Contact Info