Please provide the following contact information:

Name
Title
School Name
School Street Address
School City, State, Zip
School Phone
Summer Street Address
Summer City, State, Zip
Summer Phone
Cell Phone
E-mail Address (School Year)
E-mail Address (Summer)

Number of Students:

Number of chaperones:

Grade of students:

Approximately what time would you be able to arrive at the beach?

How much time will you be able to spend at the beach?

If available, would you be interested in staying for additional activities (e.g. tide pooling, marine-related games and demonstrations) after the cleanup?

Yes
No
Not Sure

Would you like to schedule an in-school presentation prior to the cleanup?

Yes
No
Not Sure

Any other comments/questions?