Program Request Form

Please complete this form in its entirety so we can plan the best experience for you.

Your name: * Required
Organization (if affiliated with a school, please state name of school) * Required
Your email address: * Required
Phone number: * Required
Program topic: * Required
Age or grade of participants: * Required
Anticipated number of participants: * Required
Location of class (our shelter or your site): * Required
Date/time options for your program (if applicable, please list more than one option): * Required
Special Requests (If this is for a Scout Badge or Award Program, please specify details.)

We appreciate your interest in working with us to provide Humane Education in the community. After receipt of your request, you will be contacted within a week to discuss possible dates/times for your group.

Give Us a Call:

Office Hours:

Viewing Hours:

Program Request Form

262-782-9261

262-782-3356

Elmbrookhs@ebhs.org