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School Registration

Please fill out this form to schedule a time to visit LifeTown.

1Primary Contact

2Secondary Contact

3Students

4Scholarships

5Waiver

Primary Contact
Name*
First Last
Email*
Phone*
Position with School*
School Name*
School Address*
Street Address Address Line 2 City State ZIP Code
- 1st choice of date you would like to visit?
  MM slash DD slash YYYY
  
  1st choice of date you would like to visit?
- 2nd choice of date you would like to visit?
  MM slash DD slash YYYY
  
  2nd choice of date you would like to visit?
Which time works best for you?

Secondary Contact
Name*
First Last
Email*
Phone*
Any other information we should be aware of

Students
Tell us about the students you will be bringing
School Type
- Elementary
- Middle
- High School
- Other
Other*
Number of Students*
How many visits would you like to come?*
Which days work best for you?*
- Select All
- Monday
- Tuesday
- Wednesday
- Thursday
Select all that apply

Scholarship Request
The cost to attend LifeTown will be $35 per student per visit.

Partial Scholarships are now available and all applications will be under review.

If you are applying for a scholarship, please explain how much assistance you are requesting.
Assistance Requested

After your registration is submitted, a waiver form will be emailed to you and must be filled out for each student that is going to participate in LifeTown programming.