Form Center

2. Teacher/Group Organizer First Name *
3. Teacher/Group Organizer Last Name*
5. Phone Number*
6. Email*
8. School/Organization Name
10. Grade (if applicable)
11. Age/range of students*
13. Total # of students*
14. Total # of chaperones*
16. Date(s) Requested*
18. Class Start Time*
20. Class End Time*
22. Are you requesting a visit to the Marine Life Center, or a local beach?*
    -- Select One --Marine Life CenterMarine Park BeachSqualicum BeachLarrabee State Park Beach

    Choose the Marine Life Center or beach of your choice from the drop down menu. 

24. Curriculum or Special Requests*

    Is there a particular curriculum you would like the Center staff to focus on during your visit? 

26. Other information

    Is there any other information the Center staff should know when planning for your visit?

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field