2. 
4. Offsite Visit Request Form
6. Name*
7. Email Address*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Organization/School
20. Date/Time of Event*
    Date/Time of Event

    Date/Time of Event
21. # of Attendees*
23. Age Range of Attendees*
25. Main focus of the event*
27. Additional Information for Staff (parking, special requests, etc.)

31. This form does not guarantee an off-site visit by Phillips Park Zoo staff. All requests must be made at least 1 week prior to the event and are first come, first served and subject to availability. You will receive email confirmation of your request.

    I understand that the Phillips Park Zoo staff will do their best to provide an educational and fun program. I understand that the program may be cancelled due to weather conditions, staffing constraints, or emergencies at the zoo. Zoo staff will do their best to contact me if a problem arises and will reschedule the program.

33. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature
37. The Phillips Park Zoo is a free zoo. We offer educational programs as part of a community service. If your group would like to help the zoo to continue to improve its education and conservation programs, or general care of the animals we do accept tax deductible donations through the Animal Adoption Program (https://www.aurora-il.org/1935/Animal-Adoptions)
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field