School Name_______________________________________________________

Address___________________________________________________________

City_____________________________ State_________ Zip code____________

County____________________________________________________________

Teacher's Name________________________________ Class________________

Phone_______________________________ E-mail________________________

Please provide information about your school and the class that will be involved with the Outdoor Classroom Enrichment Program offered by the Kentucky Bluebird Society:

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Please print, fill out, and mail this form to: Kentucky Bluebird Society, P. O. Box 3425, Paducah, KY 42002.