VZT: Group Form | Palm Beach Atlantic University

PLEASE READ PBA'S GROUP VISIT GUIDELINES BEFORE FILLING OUT THIS FORM.

Group Visit Request

*Agency or Group Name:

*Date (dd/mm/yy):

*Contact: First Name:

*Contact: Last Name:

*Street Adress or P.O. Box:

*City:

*State:

*Zip Code:

*Email:

*Confirm Email:

*Primary Phone Number:

*Secondary Phone Number:

*Best time to call::

*Estimated Number of Students Attending::

*Grade Range of Students Attending:

Note: Due to staffing requirements we only are able to accommodate GRADES 9-12

*Number of Chaperones:

*Number of Vehicles: Please inidcate number of cars, vans or buses

*Date You Would Like to Visit (mm/dd/yy)::

*Secondary Date (mm/dd/yy)::

Note: This does NOT confirm your date; you will receive an e-mail confirming your visit date within 3-5 days after submission

*Anticipated Time of Campus Arrival:

*Anticipated Time of Campus Departure:

Please select ALL of the activities you would like to experience while visiting with us

*Other (please list): :

Please share with us any other information or requests that might make your visit to PBA more enjoyable; or information involving the special needs of your students (i.e., wheelchair access, food allergies):

*Special Requests: Available characters remaining:

*Spam validation:

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