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2. Education Presentation Request Form

   Keep Norfolk Beautiful offers four in-person presentation programs for Kindergarten through 8th grade. Each lesson is designed to help Norfolk students learn more about their impact on the environment and what they can do to help. 

4. Requestor First Name*
5. Requestor Last Name*
6. Requestor Email*
8. Requestor Phone Number
9. Group Type*
   -- Select One --ClassroomHome School GroupLearning PodCampAfter School Club/CampOther
10. Presentation Requested*
    -- Select One --Enviroscape Landfill and Recycling Demonstration, 4th Grade and UpPreventable Journey, 3rd -5th GradeHenry the Heron, 1st-2nd Grade3R's, PreK-1st Grade
12. Facility Name*
13. Facility Zip Code*
15. Grade Level of Students*
    Please indicate what grade, or grades, will be present for the presentation.
16. Number of Students*
    Please indicate how many students are expected to be at, or participating in, the presentation.
17. Number of classes*
19. 1st Preference*
    1st Preference

    1st Preference
    Please let us know your date and time preference for the presentation. The presenter will be in touch to confirm or offer an alternate date or time if needed.
20. 2nd Preference
    2nd Preference

    2nd Preference
    Please let us know another date and time preference for the presentation in case your first preference isn't available.
22. Agreement

    - KNB staff agrees to arrive prior to the scheduled time to allow adequate time for setup before the presentation begins.

    - The requestor will ensure that an educator or assistant will be with each group at all times during the presentation.

    - KNB staff and the requestor agree to communicate any changes or issues regarding the presentation with adequate notice. 

    - KNB staff and the requestor will notify the other if a participant or staff person present at the presentation receives a positive COVID-19 test within 14 days prior to, or after, the presentation

24. Additional information, questions, comments or concerns.

    Please let us know any details that might help the presenter prepare for the presentation. Use this space if more than one class is interested in participating. List additional classes, grade level, and number of students. As well if activity will be done in one location or the presenter moving to each classroom.

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field