Farm Visit Request Form : Youth Education : Educate : What We Do : The Friends of Hilltop Hanover Farm

Farm Visit Request Form

Teacher / Contact Information

First Name: (Required)

Last Name (Required)

Email: (Required)

Work Telephone: (Required)

ext Extension

Mobile Phone: (Required)

In event of an emergency

Organization Information

Name: (Required)

School, Group, or Organization Name

Address:

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

School District:

If applicable

Visit Information

Preferred Date(s): (Required)

Preferred Start Time: (Required)

Grade/Age of Students: (Required)

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# of Students: (Required)

Enter number

Total # of Classes Attending (Required)

# of Chaperones: (Required)

Program of Interest (Required)

Choose 1

Length of Program (Required)

Will you Arrive By: (Required)

Accommodations or Modifications (Required)

Provide any special notes or details about your group.

Business/School Front Desk Contact:

Payment & Insurance

Payment in full is due 30 days before your scheduled visit (checks preferred). Please make checks payable to: The Friends of Hilltop Hanover Farm & Environmental Center Inc.

If the group chooses to stay longer than the scheduled program, there will be an additional $50/hr fee.

At least 10 business days in advance of your visit please mail, email or fax a certificate of liability insurance naming The County of Westchester as certificate holder and naming both the following as additionally insured:

1. The County of Westchester, 148 Martine Avenue, White Plains, NY 10601

2.The Friends of Hilltop Hanover Farm & Environmental Center, Inc. 1271 Hanover Street, Yorktown Heights, NY 10598.