Wings of Wonder Outreach Request Form

Ameritas Wings of Wonder Outreach Request Form
The Bird Experience Team is bringing their feathered friends to you! These traveling encounters are great for all ages, organizations and events including scouts, schools, retirement homes and special events!

Choose between two programs, Penguin Pals or Wings and Whiskers! In these experiences, you’ll gain a greater respect for birds and wildlife, learn about the bird’s natural history, their personal stories and see natural behaviors!

Filling out this form does not guarantee we can accommodate your request. A member of our team will reach out within a week to confirm final details and accept payment.

Program Days: Offered Every day but Friday.
Penguin Pals offered October 12-April 11
Wings and Whiskers offered November 21-April 11
Programs are for ages Kindergarten-Adult
Payment is due 2 weeks from order confirmation.
Payments accepted: check, credit card, purchase order.

See our Wings of Wonder Outreach Program webpage for program specifics.

Sponsored by:

Group Information
Group Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Group Type
If other, explain.
Contact Information
Name

First NameLast Name
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Is this the same Day Of program contact?
Day of Contact Name

First NameLast Name
Day of Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Day of Contact Email
example@example.com

Program Details
How many programs total do you want?
Program Reminders

Number of Programs per day
- Wings and Whiskers - 3 programs per day
- Penguin Pals - 2 programs per day
Program Length
- Wings and Whiskers - 30 minutes
- Penguin Pals - 30 minutes
Maximum Participants per programs
- Wings and Whiskers- 50 people
- Penguin Pals - 50 people

Program 1: Preferred Topics, Dates, and Times

Rows	Topic	1st Choice Date	2nd Choice Date	Time	Participants	Age/Grade Range (K-Adult)
Program 1

Are your dates/times flexible?
About Your Group
Please list any special needs/accommodations for your group.
Please list any nut or fruit allergies, or other needs/accomodations, or other important information.
Will there be a service animal or other animals present in the program room?
What type of animal will be present?
ie a service dog for cardiac alert, classroom rabbit, office cat.