Oregon Garden

5th Grade Grant-Supported
Program Request Form

Please print and complete the application below,
then mail or fax it to us at 503-873-4048

The Oregon Garden
P.O. box 155
Silverton, OR 97381

Cindy Quam
cquam1@chemeketa.edu
503-584-7256

After a review of your application, we will contact you to confirm the details of your trip.
Programs Available: Please check the class(es) you'd like to attend. Spring and Fall Curriculum

(   ) Amazing Aqua Life
(   ) Animal Tracking
(   ) Birds (From Seed to Song)
(   ) Food Web
(   ) Habitat Hike

 

(   ) Lovely Leaves
(   ) Plant Adaptations
(   ) Pollination
(   ) The Love of Insects

 

Please print clearly.

School __________________________________________________________________

Address _________________________________________________________________

City ___________________________________________ Zip Code__________________

FAX Number _____________________________________________________________

Teacher/ Contact Name _____________________________________________________

Please list other classroom teachers ___________________________________________

Phone Number/ best time to call_______________________________________________

Email address ____________________________________________________________

Grade Level of students_____________________________________________________

Approx. # of students _______________________________________________________

Approx. # classes _________________________________________________________

Approx. # of chaperones _____________________________________________________

NOTE: We request one chaperone for every 5 students. Teachers and chaperones are given free admission.

Preferred Date for visit_____________________________________________________

Alternate Dates__________________________________________________________

Arrival/ Departure Time ____________________________________________________

spacer