Booking Request - Heritage Education Services

1. Plan ahead - we need at least two weeks notice (preferably more) to plan and deliver quality programmes and resources. 2. Have your desired dates, times and alternate dates ready. 3. Ring the educator for a chat free phone 0508 Museum or fill in this form:

NB please allow 90 minutes for each session (15 minutes between sessions)

Fields marked with a * are compulsory.

Teachers Name: *

Teachers Name: * :: Teachers Name

School: *

School: * :: Name of school

Teachers Email Address: *

Teachers Email Address: * :: Teacher's Email Address

School Phone:

School Phone: :: School Phone Number

School Fax:

School Fax: :: School Fax

Teacher Cell Phone: (for day of your visit)

Teacher Cell Phone: (for day of your visit) :: Teacher Cell Phone: (for day of your visit)

Preferred Date:

Preferred Date: :: Preferred Date

Alternative Date:

Alternative Date: :: Alternative Date

Time of day:

early am
late am
afternoon

Year Group/s:

Year Group/s: :: Year Group/s

Curriculum Level/s:

Curriculum Level/s: :: Curriculum Level/s

Number of Students:

Number of Students: :: Number of Students

Number of Classes:

Number of Classes: :: Number of Classes:

Number of Teachers/Adults:

Number of Teachers/Adults: :: Number of Teachers/Adults

Special Needs or Requests:

Special Needs or Requests: :: Special Needs or Requests

Topic/ Programme:

Topic/ Programme: :: Topic/ Programme

Key Competencies and Learning Areas (SLO):

Key Competencies and Learning Areas (SLO): :: Key Competencies and Learning Areas (SLO)

Heritage Education Services is managed by South Canterbury Museum with LEOTC funding support from the Ministry of Education.

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