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

Farm Visit Request Form

Teacher/Contact Person: (Required)

Contact Email: (Required)

Contact Telephone: (Required)

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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)

Preferred Start Time: (Required)

Grade/Age of Students: (Required)

# of Students: (Required)

Enter numeric number

Total # of Classes Attending (Required)

# of Chaperones: (Required)

Program of Interest (choose 1) (Required)

Length of Program (Required)

Will you Arrive By: (Required)

Special Accommodations or Modifications (Required)

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.