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

Farm Visit Request Form

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Teacher/Contact Person: (Required)

Contact Email: (Required)

Contact Telephone: (Required)

Phone Number

ext Extension

Cellphone (in case of an emergency):

School/Group/Organization: (Required)

School/Group/Organization Address: (Required)

School District (if applicable): (Required)

Preferred Date(s) of Visit: (Required)

Hours of Visit: (Required)

Grade/Age of Students: (Required)

# of Students: (Required)

# of Chaperones: (Required)

Program of Interest (choose 1)

Sprouts- 1 hour visit
Jr Farmer- 2 hour visit
Farmer for the Day- 3 hour visit
Hybrid Farm-to-table Workshop- 3 hour visit
Farm-to-table Workshop- 3 hour visit
Farmers & Explorers
Undecided- Please contact me with more information

Will you Arrive By: (Required)

# of Vehicles: (Required)

Special Needs/Accommodations: (Required)

Business/School Front Desk Contact:

Payment & Insurance

$100 deposit due to reserve spot; remainder due at time of visit, 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 one week 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. PO Box 54, Yorktown Heights, NY 10598.

Farm Visit Request Form

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