Summer Reading Program

Library Program Request Form

* Indicates required field

Your Name: *

First

Last

Library Name (or other organization): *

Mailing Address (please include city, state, zipcode) *

Program Site Address (if different than mailing address) *

Phone Number: *

Email *

What dates are you interested in? (Please list 3 possible dates) *

Untitled *

What time would you like the program to start? (Programs are typically 50-60 minutes, but can be shortened upon request.) *

Approximate ages and/or grades of children attending *

Approximate number of children attending *

What program topic do you want DHNC to present? *

Douglas-Hart Nature Center will contact you by email or phone within a few business days of receiving your program request.

Additional Comments *

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