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1500 East Garrison Blvd.
Gastonia, NC 28054
P 704-866-6900
F 704-866-6041
Request for Group Appointment
Submitting this form does not guarantee an appointment. Our Group Appointment staff will respond to your request, book your appointment, then send written confirmation of that appointment. Fields marked with an asterisk (*) must be filled out completely.
Primary Contact's Information
First Name*
Last Name*
Telephone* - -
School Information
School Name*
School Type*
Address 1*
Address 2
Zip Code* -
School System*
School E-mail*
School Phone* - -
School Fax* - -
# Classes Attending*
# Students Attending*
Grade(s) Attending*
Pre-K K
1 2 3 4 5 6
7 8 9 10 11 12
Proposed Date(s) of Visit
First Choice*
Second Choice
Third Choice
Arrival Time*
Departure Time*
Activities Desired (Choose up to three. Call if you want more than three activities.)
Program Selection*
Program Selection
Program Selection
Lunch Plans*
Special Needs
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