SCHEDULE FORM

SCHEDULE PLANNING FORM

Back Bay Wildlife Refuge

Please complete the following information and submit a copy of this form to the Refuge no later than seven days prior to your visit. (It may be e-mailed to the Refuge --see end of form-- or printed out and mailed via the USPS.)
This exercise will assist you in organizing your activity agenda and will help you to identify any special needs that you may have (eg. equipment, videos, etc., some of which the Refuge may be able to provide; see the Equipment Resources section).

NOTE: Those items beginning with a double "**" are required for submission.

**Name of school or group:
**Date of visit:
**Grade level or age:
**Number of students:
**Number of adults:
Type of transportation:
**Number of vehicles:
Estimated driving time from school to the Refuge:
**Estimated time of arrival to the Refuge:
**Do you plan to have lunch?:
If so, at what time?:
Where?:
**At what time do you plan to leave the Refuge?:
Total time available for activities:

What particular curriculum concepts do you want to emphasize during your visit to the Refuge?:
What structured activities do you plan to carry out?:
What equipment will you need to carry out these activities? The Refuge may be able to supply some of your needs, but note that Equipment needs must be scheduled at the same time as your visit. (See Equipment lists):

Develop an agenda for your group's visit. Be sure to allow approximately 15 minutes for the Refuge orientation when you arrive. If you are working with more than one class or if you plan to divide your group into smaller units, be sure to include rotations on your schedule and indicate who will be working with each group.

What types of pre-visit planning and activities will be helpful in preparing the students?:
What safety issues will need to be discussed with the students? :
What types of post-visit follow up activities could be used back in the classroom:
Make a list of things that need to be done prior to your visit to the Refuge (ie. reserve equipment and videos, arrange for buses, etc.):

Have you attended one of our Environmental Education Workshops? [Yes/No]:
If not, are you interested? [Yes/No]:

**Your Name:
**Address:
**City:	**State:	**Zip Code:
**Phone Number:
Fax Number:
E-Mail:

If you are ready to send your form, click the Submit button.
If you want to start over with a blank form, click the Reset button.

If you prefer, you can print this form off your screen, complete it and then mail it to us at:

Refuge Manager
Back Bay National Wildlife Refuge
4005 Sandpiper Road
Virginia Beach, VA 23456-4325