Teacher First Name * Teacher Last Name * School Name * Email * School Telephone * School Address * City * Province * Please SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorth West TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code * Type of Program * I would like a program at the Gallery I would like a virtual program Program (in Gallery) Please SelectUnguided VisitThe ABCs of ArtArt AdventureArt AdventureGallery HighlightsIndigenous PerspectivesHighlights from the Indigenous and Canadian CollectionSigns and Symbols in Art Program (Distance Learning) Please SelectPeople and RelationshipsPeople and RelationshipsGallery HighlightsIndigenous PerspectivesHighlights from the Indigenous and Canadian CollectionGallery HighlightsIndigenous PerspectivesHighlights from the Indigenous and Canadian CollectionSigns and Symbols in ArtWhy Photography?Rembrandt in AmsterdamCanada and Impressionism Date of Program * Time of Program * Time zone * Please SelectPacific TimeMountain TimeCentral TimeEastern TimeAtlantic TimeNewfoundland Time Grade Level * Please SelectK1 - 34 - 67 - 8 (Sec. I-II)9 - 12 (Sec. III-V)Special Ed. Type of Classroom * Please SelectIn ClassVirtual Class Language of Program * Please SelectEnglishFrench Number of Students * Number of Chaperones Platform to be used for the webinar * Please SelectZoomMS TeamsGoogle Meet Direct telephone number in case of technical difficulties * Do your students have special needs? Yes No, proceed to next section Special Needs Students Please indicate the number of people in your group who have any of the following disabilities. In cases where a participant has multiple disabilities, indicate the number in each category. people with blindness or partial sight people with mobility impairment people who use wheelchairs people who are hard of hearing people who benefit from a portable FM assistive listening device people who require ASL or LSQ interpretation (Upon availability) people who have learned English as a Second Language (ESL) people with learning disabilities people with ADHD people with developmental or cognitive disabilities people with mental health disabilities people with autism people who use Augmentative or Alternative Communication people who require a discrete space to accommodate personal hygiene Are there particular concerns or special adaptations of which we should be made aware? Please specify Do you have participants with particular medical conditions or allergies? Please specify Comments Submit
