Teacher Contact Name *

First Name

Last Name

Emergency Contact Cell Phone *

This will only be used if needed to contact you in an emergency while on our site.

(###)

###

####

School Phone Number *

(###)

###

####

Address

Mailing address for School

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Program Time *

What time would you like the program to begin?

Hour

Minute

Second

AM PM

Date of Experience (1st Choice) *

MM

DD

YYYY

Date of Experience (2nd Choice) *

MM

DD

YYYY

Date of Experience (3rd Choice) *

MM

DD

YYYY

Tell us about your group.

My group includes people who use wheelchairs, crutches or a walker.

My group includes people who are non-verbal.

My group is primarily non-English speaking.

My group includes people who might be sensory sensitive.

My group includes people with vision loss.

My group includes people who are deaf or hard-of-hearing.

My group includes people with intellectual disabilities.

I have read and understood the following MCHS Policies & Procedures *

I agree to review all pre-visit information provided by the Manitowoc County Historical Society prior to my visit, which I will receive via email. I will have one payment ready upon arrival on the day of our tour experience, based on the invoice that I will receive. Non-emergency cancellations must be made at least 48 hours prior, or I may be subjected to a cancellation fee. Rescheduling cannot be guaranteed.

Yes, I have read and understood the policies and procedures.