Please fill out this form to request a Reinstein Woods program for your students. Requested dates and times are not confirmed until you hear from a DEC staff person. We encourage you to submit this form at least three weeks before your desired date. May, June, and October are our busiest months for guided outdoor lessons; contact us early to reserve your preferred dates.

School Tour Request Form

Contact Name *

E-mail Address *

Cell Phone *

Work Phone *

Preferred contact # (check box) *

Cell #

Work #

Best time of day to reach by phone? *

Will you be attending the program? If No, please list an alternate contact person for us to send the information to as well *

Yes

No

Alternative Contact Name *

Alternative Email Address *

Alternative Cell Phone *

School Name *

School Address *

City/town *

Zip Code *

County *

School District *

Grade level *

# of classes *

Total # of students *

Do any students have special needs (learning and/or physical disabilities)? If yes, please describe the needs of your students so that we can offer the best possible experience: *

No

Yes

Educational Challenges: *

Are the students integrated within the classes or in a self-contained class? *

What is the average grade level of student reading comprehension? *

How many (if any) students are non-verbal? *

Helpful Adaptations for the students (e.g. use of manipulatives, visuals, simple directions, etc.): *

Requested date(s)/preferred day(s) of the week—please include at least three (Note: date is not guaranteed until confirmed with DEC staff): *

Requested start time *

Guided outdoor lesson (please select a program) Exploring the Outdoors (grades PreK-1) Animal Investigations (grades 2-8)World of the Pond (grades 3-8) Forest Ecosystems (grades 7-12)Winter Challenges (grades 2-12)Other Guided outdoor lesson (please select a program)

Classroom Presentation (please select a program) Animal Tracks (grades PreK-3) CSI: Critter Sign Investigation (grades 4-8) Fantastic Frogs (grades PreK-3) Nature’s Recyclers (grades PreK-8) Skull Science (grades 4-8) Trash Talk (grades K-8) Watershed Works (grades PreK-8) Other Classroom Presentation (please select a program)

Additional Notes

If you are human, leave this field blank.

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