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Evening of Play

Virtual Outreach Interest Form

I am scheduling:
- VIRTUAL OUTREACH
- IN-PERSON OUTREACH
THIS FORM IS FOR VIRTUAL OUTREACH VISITS ONLY. IF YOU ARE TRYING TO SCHEDULE AN IN-PERSON OUTREACH, PLEASE RETURN TO THE OUTREACH PROGRAMS PAGE AND SELECT THE IN-PERSON FORM.
Name of organizer*
First Last
Email*
Phone*
Institution*
Are you a Title I institution?
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Supply kit drop-off address
If you would like the kits dropped of at an address different from that above, please include it here.

Street Address Address Line 2 City State ZIP Code
Grade level*
Select all that apply. Use the Control key to select more than one.
- Pre-K
- Kindergarten
- 1st
- 2nd
- 3rd
- 4th
- 5th
- 6th
Number of children*
Program desired*
Please select the program(s) you want us to present to your class during our virtual outreach. Use the Control key to select more than one. Grade designations reflect state standards met.
Meeting Platform
Children's Museum uses Zoom for it's outreach. Is there different platform that you would prefer to use (e.g. Teams, Google Classroom, etc?
What language would you prefer for your program?
- English
- Spanish
- Bilingual
Date - First choice*
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time*
What time should we begin the outreach?

: Hours

Minutes

AM/PM
Date - Second choice
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time
What time should we begin the outreach?

: Hours

Minutes

AM/PM
Date - Third choice
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time
What time should we begin the outreach?

: Hours

Minutes

AM/PM
Phone
This field is for validation purposes and should be left unchanged.