WildCare - Survey - Waitlist for Nature Hike Programs

Please enter the following contact information to be added to the Waitlist for a Nature Hike Program. We will contact you in the event a program becomes available.

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Name:

First Required	Last Required

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Email: Required

Phone Number:

Yes, I would like to receive e-mail from WildCare

Keep me logged in. What's this?

Question - Not Required - Please enter the preferred date and location for your Nature Hike Program. (Note: sites are day-specific: Tuesdays - Ring Mountain, Corte Madera, Wednesdays - Muir Woods, Thursdays - Miwok Meadows, China Camp, San Rafael)

Question - Not Required - Please enter an alternative date:

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Question - Required - Name of school:

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Question - Required - School telephone number and extension:

Question - Not Required - What is the school's address?

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Teacher's cell phone number:

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Question - Required - Please tell us what grade level:

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Question - Required - Approximately how many students will be participating?

Do you need to apply for a scholarship for your Wildlife Ambassador Program?

If yes, please complete the questions below:

Question - Not Required - Yes/No

Question - Not Required - What percentage of students at your school is eligible for the Free or Reduced Price Meal (FRPM) program (see link below to determine percentage):

(Click here for the link to the current year Free or Reduced Price Meal (FRPM) information on WildCare's Scholarship Information page.)

If you are able to accept a smaller scholarship it would be greatly appreciated, as this will enable us to reach even more students in the Bay Area.

Question - Not Required - What amount can you afford to contribute?

Question - Not Required - Please share how receiving this scholarship would benefit your students' educational experience?