{"id":43218,"date":"2025-09-17T11:52:43","date_gmt":"2025-09-17T15:52:43","guid":{"rendered":"https:\/\/nywolf.org\/?page_id=43218"},"modified":"2025-09-17T14:11:42","modified_gmt":"2025-09-17T18:11:42","slug":"school-group-education-program-request","status":"publish","type":"page","link":"https:\/\/nywolf.org\/programs-events\/school-group-education-program-request\/","title":{"rendered":"Education Program Request Form"},"content":{"rendered":"\n\n\t\t<h1>\n\t\t\t\n\t\t<\/h1>\n                <form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_15' id='gform_15'  action='https:\/\/nywolf.org\/programs-events\/school-group-education-programs-copy\/?fl_builder&#038;fl_builder_ui_iframe#gf_15' data-formid='15' novalidate>\n                        <h3>Contact Information<\/h3><label class='gfield_label gform-field-label' for='input_15_3'>Contact Person Name(Required)<\/label><input name='input_3' id='input_15_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_6'>Contact Person Title(Required)<\/label><input name='input_6' id='input_15_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_7'>Contact Person Email(Required)<\/label>\n                            <input name='input_7' id='input_15_7' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <h3>Facility\/Group Information<\/h3><label class='gfield_label gform-field-label' for='input_15_10'>Facility\/Group Name(Required)<\/label><input name='input_10' id='input_15_10' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_11'>Facility\/Group Contact Phone Number:(Required)<\/label><input name='input_11' id='input_15_11' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><fieldset id=\"field_15_12\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Facility\/Group Address(Required)<\/legend>    \n                                        <input type='text' name='input_12.1' id='input_15_12_1' value=''    aria-required='true'   autocomplete=\"address-line1\" \/>\n                                        <label for='input_15_12_1' id='input_15_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <input type='text' name='input_12.3' id='input_15_12_3' value=''    aria-required='true'   autocomplete=\"address-level2\" \/>\n                                    <label for='input_15_12_3' id='input_15_12_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                        <select name='input_12.4' id='input_15_12_4'     aria-required='true'   autocomplete=\"address-level1\"><option value='' selected='selected'><\/option><option value='Alabama'>Alabama<\/option><option value='Alaska'>Alaska<\/option><option value='American Samoa'>American Samoa<\/option><option value='Arizona'>Arizona<\/option><option value='Arkansas'>Arkansas<\/option><option value='California'>California<\/option><option value='Colorado'>Colorado<\/option><option value='Connecticut'>Connecticut<\/option><option value='Delaware'>Delaware<\/option><option value='District of Columbia'>District of Columbia<\/option><option value='Florida'>Florida<\/option><option value='Georgia'>Georgia<\/option><option value='Guam'>Guam<\/option><option value='Hawaii'>Hawaii<\/option><option value='Idaho'>Idaho<\/option><option value='Illinois'>Illinois<\/option><option value='Indiana'>Indiana<\/option><option value='Iowa'>Iowa<\/option><option value='Kansas'>Kansas<\/option><option value='Kentucky'>Kentucky<\/option><option value='Louisiana'>Louisiana<\/option><option value='Maine'>Maine<\/option><option value='Maryland'>Maryland<\/option><option value='Massachusetts'>Massachusetts<\/option><option value='Michigan'>Michigan<\/option><option value='Minnesota'>Minnesota<\/option><option value='Mississippi'>Mississippi<\/option><option value='Missouri'>Missouri<\/option><option value='Montana'>Montana<\/option><option value='Nebraska'>Nebraska<\/option><option value='Nevada'>Nevada<\/option><option value='New Hampshire'>New Hampshire<\/option><option value='New Jersey'>New Jersey<\/option><option value='New Mexico'>New Mexico<\/option><option value='New York'>New York<\/option><option value='North Carolina'>North Carolina<\/option><option value='North Dakota'>North Dakota<\/option><option value='Northern Mariana Islands'>Northern Mariana Islands<\/option><option value='Ohio'>Ohio<\/option><option value='Oklahoma'>Oklahoma<\/option><option value='Oregon'>Oregon<\/option><option value='Pennsylvania'>Pennsylvania<\/option><option value='Puerto Rico'>Puerto Rico<\/option><option value='Rhode Island'>Rhode Island<\/option><option value='South Carolina'>South Carolina<\/option><option value='South Dakota'>South Dakota<\/option><option value='Tennessee'>Tennessee<\/option><option value='Texas'>Texas<\/option><option value='Utah'>Utah<\/option><option value='U.S. Virgin Islands'>U.S. Virgin Islands<\/option><option value='Vermont'>Vermont<\/option><option value='Virginia'>Virginia<\/option><option value='Washington'>Washington<\/option><option value='West Virginia'>West Virginia<\/option><option value='Wisconsin'>Wisconsin<\/option><option value='Wyoming'>Wyoming<\/option><option value='Armed Forces Americas'>Armed Forces Americas<\/option><option value='Armed Forces Europe'>Armed Forces Europe<\/option><option value='Armed Forces Pacific'>Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_15_12_4' id='input_15_12_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                    <input type='text' name='input_12.5' id='input_15_12_5' value=''    aria-required='true'   autocomplete=\"postal-code\" \/>\n                                    <label for='input_15_12_5' id='input_15_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <input type='hidden' class='gform_hidden' name='input_12.6' id='input_15_12_6' value='United States' \/>\n                <\/fieldset><h3>Program Information<\/h3><label class='gfield_label gform-field-label' for='input_15_14'>Grade or Age of Group(Required)<\/label><input name='input_14' id='input_15_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><fieldset id=\"field_15_15\"><legend class='gfield_label gform-field-label'>Are you a Title 1 facility?(Required)<\/legend>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes'  id='choice_15_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_15_0' id='label_15_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_15_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_15_1' id='label_15_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Unsure'  id='choice_15_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_15_2' id='label_15_15_2' class='gform-field-label gform-field-label--type-inline'>Unsure<\/label>\n\t\t\t<\/fieldset><label class='gfield_label gform-field-label' for='input_15_16'>Date preference(Required)<\/label><textarea name='input_16' id='input_15_16' class='textarea small'  aria-describedby=\"gfield_description_15_16\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea>Please provide three potential days and times for your program. <fieldset id=\"field_15_17\"><legend class='gfield_label gform-field-label'>Have you booked with us before?<\/legend>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Yes'  id='choice_15_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_17_0' id='label_15_17_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='No'  id='choice_15_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_17_1' id='label_15_17_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Unsure'  id='choice_15_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_17_2' id='label_15_17_2' class='gform-field-label gform-field-label--type-inline'>Unsure<\/label>\n\t\t\t<\/fieldset><label class='gfield_label gform-field-label' for='input_15_18'>How did you find out about us?<\/label><input name='input_18' id='input_15_18' type='text' value='' class='large'      aria-invalid=\"false\"   \/><fieldset id=\"field_15_19\"><legend class='gfield_label gform-field-label'>What is your facilities preferred payment method?<\/legend>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Credit\/Debit'  id='choice_15_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_19_0' id='label_15_19_0' class='gform-field-label gform-field-label--type-inline'>Credit\/Debit<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Check'  id='choice_15_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_19_1' id='label_15_19_1' class='gform-field-label gform-field-label--type-inline'>Check<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='gf_other_choice'  id='choice_15_19_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_19_2' id='label_15_19_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_15_19_other' class='gchoice_other_control' name='input_19_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/fieldset><fieldset id=\"field_15_21\"><legend class='gfield_label gform-field-label'>Are you looking to book an onsite visit to the WCC, an offsite visit to your facility, or a virtual program?(Required)<\/legend>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Onsite Visit'  id='choice_15_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_21_0' id='label_15_21_0' class='gform-field-label gform-field-label--type-inline'>Onsite Visit<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Offsite Visit'  id='choice_15_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_21_1' id='label_15_21_1' class='gform-field-label gform-field-label--type-inline'>Offsite Visit<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Virtual Field Trip'  id='choice_15_21_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_21_2' id='label_15_21_2' class='gform-field-label gform-field-label--type-inline'>Virtual Field Trip<\/label>\n\t\t\t<\/fieldset><label class='gfield_label gform-field-label' for='input_15_23'>Number of individuals age 12+(Required)<\/label><input name='input_23' id='input_15_23' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_24'>Number of individuals under age 12(Required)<\/label><input name='input_24' id='input_15_24' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/><fieldset id=\"field_15_25\"><legend class='gfield_label gform-field-label'>Does a member of your group require assistance walking up hills?(Required)<\/legend>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_15_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_25_0' id='label_15_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_15_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_25_1' id='label_15_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Unsure'  id='choice_15_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_25_2' id='label_15_25_2' class='gform-field-label gform-field-label--type-inline'>Unsure<\/label>\n\t\t\t<\/fieldset><label class='gfield_label gform-field-label' for='input_15_33'>What offsite program are you interested in?(Required)<\/label><input name='input_33' id='input_15_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_29'>Are there any accessibility adaptions requested for your group?<\/label><input name='input_29' id='input_15_29' type='text' value='' class='large'      aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_34'>What virtual program are you interested in?(Required)<\/label><input name='input_34' id='input_15_34' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><fieldset id=\"field_15_31\"><legend class='gfield_label gform-field-label'>What is your preferred virtual platform?(Required)<\/legend>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Zoom'  id='choice_15_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_31_0' id='label_15_31_0' class='gform-field-label gform-field-label--type-inline'>Zoom<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Google Classroom'  id='choice_15_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_31_1' id='label_15_31_1' class='gform-field-label gform-field-label--type-inline'>Google Classroom<\/label>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='gf_other_choice'  id='choice_15_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_31_2' id='label_15_31_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_15_31_other' class='gchoice_other_control' name='input_31_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/fieldset><label class='gfield_label gform-field-label' for='input_15_32'>Are there any accessibility adaptions requested for your group?<\/label><input name='input_32' id='input_15_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_26'>Do you have any additional information you&#039;d like to share?<\/label><input name='input_26' id='input_15_26' type='text' value='' class='large'      aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_15_35'>Phone<\/label><input name='input_35' id='input_15_35' type='text' 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SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth 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