3R School Program Request Form

First Name

Last Name

Phone Number

Name of School/Group

Grade(s)

Number of students

Note: Maximum capacity at Hartland Learning Centre is 35 people.

Number of adults

Note: Maximum capacity at Hartland Learning Centre is 35 people.

For which program(s) would you like to register your class?

Note: Programs may consist of a workshop, workshop + tour, or just a tour. If you would like both a tour and a workshop, please check both boxes.

That's Not Garbage (Grades K-3; 45 mins.)

3Rs Unwrapped (Grades 4-5; 1 hr.)

Digging Deeper (Grades 5-8; 1 hr.)

Custom Program (Grades 6-12; 1 hr.)

Tour of Hartland landfill and recycling facility (K-12; 1 hr.)

Are you able to coordinate transportation to and from Hartland Learning Centre (1 Hartland Avenue, Victoria BC)?

Yes, we have a bus.

Yes, we will rent a bus.

Yes, with parent drivers.

No, we would like to request an inclass workshop.

Can your transportation method also be used for the tour portion of the program?

Yes, our bus and driver are available for the tour.

No, our bus and driver are unavailable for the tour.

Date and Time (first choice)

Date and Time (second choice)

Date and Time (third choice)

Are there specific areas of interest, questions or learning outcomes you would like us to address?

Do you have any other questions or comments?

Personal information contained on this form is collected under the authority of the Local Government Act and is subject to the Freedom of Information and Protection of Privacy Act. The personal information will be used for purposes directly associated with this project. Inquiries about the collection or use of information in this form can be directed to Glenn Harris, Senior Manager, Environmental Protection, Capital Regional District 250.360.3090.

3R School Program Request Form

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