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**BLM Table Rocks Environmental Education Program**

**2007 Hike Registration Form**

**1) Full Name of School and/or Program**
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**2) Mailing address Street/P.O. Box**
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**City
\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**State\_\_\_Zip\_\_\_\_\_\_\_**

**3) E-mail address** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Phone
number** (541) \_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Ext**. \_\_\_\_

**4) Grade Level/Adult Group** \_\_\_\_ **Number of participants**
\_\_\_\_**Number of chaperones** \_\_\_\_

*(Must have 1 chaperone per 10 students)*

**5) Teacher/s and/or program lead/s:** (Mr. Ms.
Mrs.)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Mr. Ms.
Mrs.)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Mr. Ms.
Mrs.)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**6) Preferred Dates** *(April 3rd through June 8th. Fridays fill fast.
No hikes on Mondays. Please pick three dates.)*:

**1^st^ Choice**:\_\_\_­­­­­­­­­­­­\_\_\_\_­­­­\_\_\_ **2^nd^
Choice**:\_\_\_\_\_\_\_\_\_\_\_\_ **3^rd^
Choice**:\_\_\_\_\_\_\_\_\_\_\_

**7) Trail preference** (check one): **□** **UPPER** (2.5 miles) *or*
**□** **LOWER** (3.5 miles)

**8) Please indicate your arrival and departure times from the Table
Rock parking lot. To take part**

**in a guided hike on the Table Rocks you must allow at least four hours
to complete your hike.**

*(Most begin at 9:00 am)* **Arrival Time** \_\_\_\_\_\_\_\_\_\_\_
**Departure Time** \_\_\_\_\_\_\_\_\_\_

**9)** All hikes include lessons about Table Rocks flora, fauna,
geology, cultural history, and natural history.

**Is there a topic or area of interest that you would like us to
emphasize?**
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**10) Would you like a Spanish speaking hike guide?** **YES □** **NO □**

**11) Do you want a pre-hike, classroom presentation?** **YES □ NO □**

(Space is limited. We will contact you to schedule a presentation.)

**12) Would you like to receive the Table Rocks activity packet?** **YES
□ NO □**

**13) Please explain any individual needs or group concerns**. (i.e.,
medical concerns)

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**14)** If you are **not** using a BLM hike leader, complete the
appropriate box below and indicate

the day and location you will be hiking. This will avoid conflict with
our scheduled groups.

> **□** Will **NOT** be using a BLM hike leader \_\_\_\_\_\_\_\_\_\_\_\_
> Date of Hike
>
> □Upper Table Rock
>
> □Lower Table Rock

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
For Office Use
Only\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**
Information letter **□** Mailed **□** Faxed Confirmation call \_\_\_\_\_
Classroom Presentation:

Date: Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Time: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_