Schedule Request Form Step 1 of 2 50% School Name*Contact Person*Email address*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code # of years you have partnered with Camp Joy*School District*Principal* First Last School Phone#Committed to a 2-year contract (only 1 year deposit required)*YesNo# of Joy programs your school attended last year*Have you come to Joy for the past 5 years?*YesNoHow is your program Funded?*Cost Directly to FamiliesSchool Supported (i.e. PTO)Grant FundedCorporate SponsorOtherDate Choice*1234Winter (Jan-Feb 2014)Date Choice*1234Spring (Mar-June 2014)Date Choice*1234Summer (Aug 2014)Date Choice*1234Date Preference Winter (Jan-Feb 2014)1st Choice2nd Choice3rd Choice Date Preference Spring (Mar-June 2014)1st Choice2nd Choice3rd Choice Date Preference Summer (Aug 2014)1st Choice2nd Choice3rd Choice Date Preference Fall (Sep-Dec 2014)1st Choice2nd Choice3rd Choice Dates your school will be unable to attend Camp Joy (Spring Break, Testing Periods, etc): Stay at Camp Joy or offsite location*At Camp JoyAt Offsite LocationTo Be DeterminedProgram Length*Number of Days (1 - 4.5)Arrival TimeDeparture TimeNumber of Meals Meal Type*FamilyBuffetTransportation*School BusesCarsClient Logistics*Total # of students from school# of sessions/visits (max 130 per session)Total # of students per visit# of extra chaperones (1:12 ratio required) Will teachers stay separate from students or in one of the Guest Houses?*Separate from StudentsIn Guest HousesSpecific Program Requests - Living History SURR (Survival on the Underground Railroad) TOC (Trial of the Century Indoor SURR option) TOT (Trail of Tears) Specific Program Requests (3 hours outdoor interactive plays that require at least 1 class periods prior to evening program): Specific Program Requests - Adventure Elements (High Ropes)* Climbing Wall Crate Climb Dangle Duo Flying Squirrel Gemini (14 yrs old+) Pamper Pole Polaris Orion Tower Quantum Leap SOAR Adventure Elements (Most adventure elements take 3 hours or 1 class period for 30 students)Specific Program Requests - Adventure Elements (Low Ropes)* Group Initiatives Group Wall (1.5 hours) Adventure Elements (Most adventure elements take 3 hours or 1 class period for 30 students)Any other notes you want to add?CommentsThis field is for validation purposes and should be left unchanged.