Rivers Are Alive Program Info Request Please complete this form to reserve a Rivers Are Alive program for your school. If you have any questions, please contact us. Step 1 of 2 50% Educator Name* First Last School Name* School 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*Email* Enter Email Confirm Email Have you done a Rivers Are Alive program with us before?* Yes No Number of Students* Number of Teachers* Number of Chaperones* Grade Level* Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Where would you like your Rivers Are Alive program to be located?* On the river At the school yard In your classroom NPS Visitor Center Virtual Program date preference* MM slash DD slash YYYY Other possible dates for program Check all the time options that work for you:* Morning Afternoon Half day Full day 1 hour Other Do you have a preferred program(s)? (e.g. Wild River Journey, Mucking, Birding, etc.)What accommodations do you need to support students with special needs?How will this field trip meet your curriculum goals?How did you hear about Rivers Are Alive?*National Park Service websiteNational Park Service social mediaWild Rivers Conservancy websiteWild Rivers Conservancy social mediaRivers Are Alive brochureMy school has been participating in this programFrom another educator/word of mouthSelect an option.Do we have permission to take photos of your students for promotional material?* All my students have permission to be photographed. Some of my students have permission to be photographed, but not all. None of my students have permission to be photographed. School DemographicsOptional, but completing this section helps to keep Rivers Are Alive programs free and is useful for grant applications.School Title One Status Free and Reduced Lunch Percentage School DemographicsPlease indicate percentage.Hispanic or Latino American Indian or Alaska Native Asian Black or African-American Native Hawaiian or other Pacific Islander White Two or more races Signature*NameThis field is for validation purposes and should be left unchanged.