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In-Class K- 12 Program Request

Teachers may use this form to request an in-class or field trip visit with Nanaimo Science.

Step 1 of 3

Contact Details

Teacher Name(Required)

First Last

Teacher Email(Required)

Enter Email Confirm Email

Program Details

Grade Level(s)?(Required)

How many students (approx)?(Required)

Please enter a number from 1 to 30.

Which program are you interested in?(Required)

Check out the options at the bottom of the page here: https://nanaimoscience.org/programs-for-schools/in-school-programs/

Date Details

What date would you prefer?

First Choice

What date would you prefer?

Second Choice

Program Start Time

Programs are typically one hour long and can start as early as 9:00am. If booking multiple of the same programs for the same day, note preferred schedule in comments below.

Comments or things we should know ahead of time?

Payment Information

Please fill out the following information so we can create an invoice to your school after we have confirmed booking details with you.

Address Invoice to:

First Last

School

School Name Street Address City State / Province / Region ZIP / Postal Code E-mail (if different from above)

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