Teacher First Name * Teacher Last Name * School Name * School Address * City * Province * Please SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorth West TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code * School Telephone * Email * Type of Program * I would like a program at the Gallery I would like a virtual program Program (in Gallery) On-site school programs are temporarily suspended Program (Distance Learning) * Please SelectGrades K–3 - People and RelationshipsGrades K–3 - Spaces and PlacesGrades 4–6 - People and RelationshipsGrades 4–6 - Spaces and PlacesGrades 4–6 - What and WhyGrades 4–6 - Art in CanadaGrades 4–6 - Indigenous PerspectivesGrades 4–6 - Photography in CanadaGrades 7–12 / Sec I–V - Gallery HighlightsGrades 7–12 / Sec I–V - Signs and Symbols in ArtGrades 7–12 / Sec I–V - Art in CanadaGrades 7–12 / Sec I–V - Indigenous PerspectivesGrades 7–12 / Sec I–V - Photography in Canada Time zone * Please SelectPacific TimeMountain TimeCentral TimeEastern TimeAtlantic TimeNewfoundland Time Time of Program * Date of Program * Grade Level * Please SelectK1 - 34 - 67 - 8 (Sec. I-II)9 - 12 (Sec. III-V)Special Ed. Type of Classroom * Please SelectIn ClassVirtual Class Platform to be used for the webinar * Please SelectZoomMS TeamsGoogle Meet Direct telephone number in case of technical difficulties * Number of Students * Number of Chaperones Language of Program * English French 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
