Group Program Inquiry Form

Want to book a program with us? Fill out this form to get started! Please be as accurate as possible in order to speed up the booking process.

Contact Information

Name of Facility

Address of Facility

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Billing Address

If different from mailing address

Contact Name

First Name

Last Name

Phone

(###)

###

####

Position

Program Information

Number of Students

We can accommodate groups up to 40 students. For groups over 40, we may need to schedule additional date(s) or will need to schedule on Tuesday, Wednesday, or Thursday to ensure we have enough staff.

Grade/Age of Students:

Number of Adults

Requested Program Name

On-site at Flat Rock Brook or outreach at your facility?

Group requires the picnic area:

Program Date and Time Preferences

We will do our best to accommodate date and time requests, but nothing is guaranteed until payment has been received.

1st Choice Date

YYYY

1st Choice Time

Hour

Minute

Second

2nd Choice Date

YYYY

2nd Choice Time

Hour

Minute

Second

3rd Choice Date

YYYY

3rd Choice Time

Hour

Minute

Second

Payment Options

Please fill out these fields as accurately as possible so we can streamline the payment process.

Preferred Payment Type

Let us know how you would like to pay after you receive an invoice.

Do you require a W-9 and/or PO?

Please check which you need, if any.

W-9

Anything else we need to know?

Submission of this form does not guarantee program booking/requested dates. A Flat Rock Brook representative will be in touch via email with next steps. Thank you!

Group Program Inquiry Form

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