Wrightstown Booking Request Form

Thank you for booking a presentation with a Brown County Dairy Ambassador.  Please complete this form in its entirety so we can properly schedule your class for its program!  Use the final comments for any special instructions you have for your presenter so they are prepared for your class (ie: special parking instructions, special needs in the classroom, food allergies, etc).


 

School Information - Complete once for each booking day

 

School District

School Name

School Street Address

School City

Contact Person Name

Contact Person Email

Contact Person Phone

 

 

Preferred Day of the Week & Times

 

First Choice Date & Time

Second Choice Date & Time

Third Choice Date & Time

 

 

Classroom Sections:

Fill in one block per classroom that will have a speaker this day: 

Classroom 1

 

Teacher Name

Grade Level

Room Number

Start Time

Stop Time (45 minutes)

Number of Students

Email Address

What Subject Matter Will This Presentation Accompany?

Classroom has projector & screen?

Classroom has Smart board?

Special Needs or Comments

 

Classroom 2

 

Teacher Name

Grade Level

Room Number

Start Time

Stop Time (45 minutes)

Number of Students

Email Address

What Subject Matter Will This Presentation Accompany?

Classroom has projector & screen?

Classroom has Smart board?

Special Needs or Comments

 

Classroom 3

 

Teacher Name

Grade Level

Room Number

Start Time

Stop Time (45 minutes)

Number of Students

Email Address

What Subject Matter Will This Presentation Accompany?

Classroom has projector & screen?

Classroom has Smart board?

Special Needs or Comments