Contact Information

First Name

Last Name

Phone Number

Email

Group Information

School or Organization Name:

School District and/or Neighborhood Name:

Total Number of participants:

Age Group or Grade Level?

Program Information

What program do you want to schedule? Check all that apply.

Glass Class (multi visit)

Mosaic (single visit)

Fusing (single visit)

Glassblowing Demonstration (Hot Wheels)

Flameworking Demonstration

Other…

Other (FILL IN TEXT)

Which Glass Class? Choose from the following list.

Glass Garden

Glass Dinner Party

Craft and Class

Pattern, Shape, and Color

Outer Space Glass Adventure

Jewelry Making

Collaborative Mosaics

When would you like to host a program? Please include all possible dates and times. Reservation requests should be submitted at least 3 weeks in advance.

Scholarship Information:

Would you like to be considered for a scholarship?

- Select -YesNo

Do 50% or more of your students qualify for free or reduced lunch?

- None -YesNo

What is an appropriate price for your students?

Comments/Questions:

Submit