Contact Information

Primary Phone Number: -- Select one -- Work Cell Home Other

Secondary Phone Number: -- None selected -- Work Cell Home Other

Best Time to Contact You:

Schedule Availability

Program Session: -- Select one -- Fall (Sept-Nov) Spring (March-May) Summer (June-Aug)

Preferred Dates: First Choice: Second Choice:

Arrival Time: a.m./p.m. Departure Time: a.m./p.m.

Is your schedule flexible? Yes No If yes, please check available months and days of the week:

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Mon Tues Weds Thurs Fri Sat

Lunch

Programs can last between 1-3 hours. Lunch is not available on the farm; however, participants are welcome to bring their own lunches and picnic in the grass under shade trees.

Will you have lunch here? -- Select one -- Yes No If yes, what time?

Travel Plans

How do you plan to travel here? -- Select one -- Bus Van Parent drivers Other If other, please describe:

Group Description

Estimated Group Size

Maximum group size is 50 students. We require at least one adult for every 10 students.

Estimated Number of Adult Leaders:

Estimated Number of Students: Age Range:

Grade(if applicable):

What percentage of students qualify for Free or Reduced Lunch?

Special Needs Considerations:

Youth at Risk Physically Impaired/Mobility Issues Developmentally Delayed/disabled

ESL (Specify native languages):

How many special needs participants are there in the group?

Program Fee and Transportation Scholarship

Program Fee: The Food Literacy Project depends on donations to support our work, and contributions from program participants constitute an important part of our operating budget. While no one will be turned away for lack of funds, we request $5-10 per participant.  A $10 donation per participant enables us to make our programs available to many low-income youth, adults, and families. You can bring the payment with you on the day of the field trip.

Please select the amount per participant that you can pay: -- Select one -- less than $5/partipant $5/participant $6/participant $7/participant $8/participant $9/participant $10/participant

Do you wish to make an additional donation to FLP? Yes No Amount:

Transportation Scholarship

For a limited time, FLP has funds available ($150/group maximum) to assist with bus transportation costs. Qualification is based on financial need. If you are interested in this scholarship, please check here and we will discuss it with you.

How did you hear about the Food Literacy Project?

JCPS Monday Memo Mailing Word of Mouth Picked up brochure at public place or event

Other (please describe):

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