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2. Name of Requestor*
4. Phone Number*
5. Email*
7. Date & Time of Visit*
   Date & Time of Visit

   Date & Time of Visit
8. Note

   Zoomobile programs are offered from October through March and are only available Mondays, Wednesdays, or Fridays 9:00AM-4:00PM

10. Name of School, Business, or Group*
12. Street Address*
14. City*
15. State*
16. Zip*
18. Distance From Zoo*

    1. Within the boundaries of school districts 91 & 93
    2. Within 30 miles of the Idaho Falls Zoo
    3. Between 30 to 50 miles away from the Idaho Falls Zoo
    4. 50 to 99 miles away from the Idaho Falls Zoo
    5. 100 to 149 miles away from the Idaho Falls Zoo
    6. 150 to 200 miles away from the Idaho Falls Zoo

    Choose one.
19. Type of Business Model*

    1. Non profit
    2. For Profit

    Choose one.
20. Type of Program (please select one)

    1. In-person
    2. Virtual
22. Please Note

    Animals are available for Zoomobiles up to 60 miles from the Idaho Falls Zoo. Zoomobiles beyond 60 miles will only have biofacts provided.

23. Tax Exempt Number
25. Grade*

    1. Not Applicable
    2. Preschool
    3. Kindergarten
    4. 1st

    1. 2nd
    2. 3rd
    3. 4th
    4. 5th

    1. 6th
    2. 7th
    3. 8th
    4. 9th

    1. 10th
    2. 11th
    3. 12th
    4. Upper Education
27. Number of Participants*

    1. Less than 40
    2. 40 to 100
    3. 101 or more

    If you're requesting additional performances, mark the largest group size.
28. Additional Performances*

    1. 0
    2. 1
    3. 2
30. Comments
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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