Education Program Confirmation Form Step 1 of 2 50% Program InformationDate of Program* Date Format: MM slash DD slash YYYY Time of Program Start* : HH MM AM PM Time of Program End* : HH MM AM PM Name of School or Organization* Number of Participants*Grade of Participants*Contact InformationName* First Last Email* Name of Contact Person who will be on-site during the field trip*Cell phone number for Contact Person*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone* Program DetailsNumber of Chaperones*Programs Requested Catch a Bay Critter Remarkable Oyster Birds of Prey Pellet Dissection (with Birds of Prey presentation) Dead Log Scavenger Hunt Build-a-Buoy - STEM Guided Kayak 4th Grade QACPS BioBlitz (meadow, forest, Bay investigations) Other (Please discuss additional options with CBEC Staff)Are you a Title I school?*YesNo Additional Information Our typical programs are four hours long, however we are flexible with your schedule and group’s needs. Most field trips are $17 per student, with no charge for chaperones. Minimum price for a 4-hour field trip is $250. Contact CBEC Staff if this cost is prohibitive and lower fees can be discussed, especially for small groups. Call to discuss pricing for shorter, longer, or specialized trips. If there are any special requirements that the CBEC staff needs to be aware of, please include these here.Special RequirementsContract Please read the information below carefully. Contact CBEC should you have any questions or concerns. This Program Request Form and a $50 deposit must be completed within 10 business days of scheduling a program with CBEC to hold your program date(s). You may pay deposit online or mail a check made out to CBEC to PO Box 519 Grasonville, MD 21638. Remaining balance is due in full on the day of your scheduled trip. Please review your Program Request form to ensure accuracy. If anything changes, such as your start or end time, number of students or chaperones attending, or special needs/requests please email us immediately. Contact Education Manager, Anna Youngk at firstname.lastname@example.org , 410-827-6694, or 443-926-3319 (direct line for day of communication). CBEC reserves the right to cancel a program due to severe weather conditions. Every effort will be made to reschedule a cancelled program. All programs cancelled by CBEC will result in a full refund of all fees. Programs cancelled by Organization or Contact Person with less than 72 hours notice must pay 25% of the program fee, in addition to the non-refundable deposit. This is to cover staff time and expenses as we cannot schedule another group on that date with such short notice. The only exception is for school closures or delays where no cancellation fee will be charged, but every effort will be made to reschedule.Deposit Price: $50.00 NameThis field is for validation purposes and should be left unchanged.