Southwest Dairy Farmers

Mobile Classroom Request Form

*required information

* County:

* School Dist.:

* Name of school:

Mailing address:

* Physical address:

City:

State: Zip:

* Phone #:

Fax #:

* Contact person:

* Position:

After-hours
emergency phone #:

Please indicate four choices of dates that would work well with your school’s schedule.

1.
2.
3.
4.

We will try our best to accommodate you on one of these dates.

ENROLLMENT DATA
Grade	# of Students	# of Classes	Time Schedule
PK			to
K			to
1st			to
2nd			to
3rd			to
4th			to
5th			to
6th			to

OUR GOAL: EDUCATION & COMMUNICATION

General Information
The Mobile Dairy Classroom is a division of the Southwest Dairy Museum Inc., a non-profit, educational organization that is funded by dairymen across the southwest.
The Dairy Classroom is a free program for schools, fairs and festivals. It’s a traveling milking parlor, carrying a live cow and providing an oral presentation, a milking demonstration and a question and answer session.
The Classroom will need a 45 to 50 foot parking space and adequate seating area for the children. Each teacher will receive educational material for their classroom relating to the dairy industry. The Instructor will also leave a video with the principal/coordinator for future use. Click here for available locations.

Each Dairy Classroom has a very large coverage area with many students waiting to see the cow and hear the Dairy Story therefore, we need to see as many students as possible because the classroom cannot visit again for two to three years.

The presentations are enjoyed by all ages, but are targeted toward pre-kindergarten through sixth grade. Instructors can teach 100 - 200 children per presentation at consecutively scheduled sessions.

You will receive written confirmation stating the date and time your school has been scheduled. In the event a scheduling problem/conflict should arise, contact your Classroom Instructor immediately for other arrangements.

Please return a map or layout of your campus indicating the location selected for the Classroom and the student seating area with this request. Using official highway numbers, street names and compass directions, please provide directions from the nearest major highway or interstate to your school. Please do not send Internet maps.

I understand the physical requirements for the 36 foot Classroom and will be able to provide the necessary arrangements for accommodations.

I further understand that the Mobile Dairy Classroom is an educational program and agree to instruct the students and faculty that excellent behavior is expected.

* Name of Principal: