Online Youth Program Request Form

Reinstein Woods Youth Program Request Form

You can use this form to make your initial request for a youth program. Requested dates and times are not confirmed until you hear from a DEC staff person. Please submit this form at least three weeks before your desired date.

Youth Program Request Form

First Name *

Last Name *

E-mail Address *

Work Phone

Cell Phone *

Home Phone

Preferred contact # (check box) *

Work #

Cell #

Home #

Best time of day to reach by phone *

Organization Name *

Address *

City/town *

Zip Code *

County *

Age(s) of Children *

Do any children have special needs? If yes, please describe the function level and needs. *

YesYes

No

Number of Children *

Number of Adults *

Guided outdoor lesson (please select a program) Animal Signs (grades 2 and older) Evening Adventure (all ages) Exploring the Outdoors (grades PreK-1) Winter Challenges (grades 2 and older) Other Guided outdoor lesson (please select a program)

In-school program (please select a program) Amazing Owls Animal Tracks CSI: Critter Sign Investigation Fantastic Frogs Nature’s Recyclers Skull Science Trash Talk Watershed Works Other In-school program (please select a program)

Requested date(s) *Note: date is not guaranteed until confirmed with DEC staff. *

Requested start time *

Additional Information

If you are human, leave this field blank.

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