Foundation for Ohio River Education
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Registration Form
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Please contact
Nick Callahan
with any questions. Thank you!
Name of School
*
Grade(s) / Type of Class
*
Curriculum Type
*
Rate Your River (Grades 4-12)
River Report Cards (High school only)
School Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County
*
School Phone
*
School Fax
Contact Person
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Position
*
Email
*
Enter Email
Confirm Email
Cell Phone Number (not required, but helpful in the event of a last-minute weather delay or cancellation)
Number of Participants (limit 50 students/day grades 4-8; limit 40 students/day grades 9-12)
*
Please enter a number from
1
to
50
.
Number of Chaperones (3 adults required)
*
Please enter a number greater than or equal to
3
.
Are there any students with special needs who will be coming on the trip?
*
No
Yes
River REACH programs run on Tuesdays, Thursdays, and Fridays
*
Preferred Date
Alternate Date #1
Alternate Date #2
Percentage of students in school participating in the Free and Reduced Lunch Program (this number is required to qualify for program discounts)
*
What time does your class typically eat lunch
*
:
Hours
Minutes
AM
PM
AM/PM
Message / Comments (Optional)
Phone
This field is for validation purposes and should be left unchanged.