Survey - Education Field Trip Registration - Humane Society of Missouri

Ready to Schedule your Trip?

Please allow 2-4 weeks notice to ensure availability of space, resources and a specially trained teacher.

PLEASE NOTE: Completion of this form does NOT confirm your field trip. A representative from HSMO's Education Department will contact you to confirm all details.

At this time, Education Programs take place at HSMO's Macklind Ave. Headquarters ONLY. 1201 Macklind Ave., St. Louis, MO 63011 (Across from the Zoo and next to the Science Center)

Please fill out the following information below to help us schedule your fieldtrip:

*1.

Question - Required - Requested date of presentation (please submit at least 2-4 weeks in advance:

*2.

Question - Required - Requested time of presentation (between 10:30am and 6pm, Monday through Friday, 10:30am-5pm Saturday or noon-4pm Sunday):

*3.

Question - Required - Name of group, school, or organization, including Troop No.:

*4.

Question - Required - School District (if applicable). If none, please enter NONE, as this is a required field:

*5.

Question - Required - Age of attendees:

*6.

Question - Required - Approximate number of attendees (do not include chaperones)

*7.

Question - Required - Any special needs we need to be aware of in order to ensure the best experience for your group? If not, please enter NONE, as this is a required field.

8.

Question - Not Required - Do you have any other questions about your visit?

9.

How did you hear about HSMO's Education Programs?

(Select one of the available choices or enter a different value.)
Question - Not Required -

10.

Contact Information


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Phone Number: Required
	Yes, I would like to receive e-mail from Humane Society of Missouri - http://www.hsmo.org
	Yes, I would like to receive postal mail from Humane Society of Missouri - http://www.hsmo.org

*11.

Question - Required - Please include cell no.

*12.

Question - Required - What topics would you like to cover?

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