Fairmount Waterworks Summer Visit Request Form

Fairmount Water Works Interpretive Center

Summer Visit Request Form

Note: please review our Educational Programs page prior to filling out the form below.

Please fill out all fields carefully. Fields with an asterisk (*) are required entries.

	CONTACT INFORMATION:
Group name *
Leader name *
Street Address
City
State
Zip Code
Leader phone number (school) *
Alt Leader contact phone number (cell)
Alt Leader contact phone no. (home)
Leader contact email address (school) *
Alternate Leader email address (home)
Preferred date of visit*
Alternative date of visit*
	GROUP VISIT INFORMATION:
Number of participants (up to 40) *
Ages of participants *
Number of chaperones * Note: 1 per 10 participants is required
Summer educational program	Green City, Clean Waters: Following Nature's Lead
	SPECIAL NEEDS:
Are any participants hearing impaired?	Yes: No:
Are participants physically disabled?	Yes: No:
Are any participants learning disabled?	Yes: No:
Additional notes or questions:
	LUNCH:
	We do not have a designated lunch facility. Lunch can be held outside weather permitting.

Please provide any additional notes or special requests here.
	Contact Us: Education Department (215) 685-0721 Fairmount Water Works Interpretive Center 640 Waterworks Drive Philadelphia, PA 19130