Contact Details  -  School

School:    ________________________________________________________________________

Address:  _____________________________________________   Phone: _______________

 ______________________________________________   Fax: _________________

Address of entrance (to unload equipment):

______________________________________________

______________________________________________

Contact Details  -  Teacher

Name: ____________________________________________________         

Email: ____________________________________________________  

Direct Phone Number: __________________________

Best time to contact by phone to confirm booking:

__________________________________________________________

Have you used our service before?  ___________________________________________________

How did you hear about us?  ________________________________________________________

About Your School

            School commences at   _________    am   then    ________    periods of    ________    minutes each

            Recess from    ________    to    ________ then    ________    periods of    ________    minutes each

            Lunch from     ________    to    ________ then    ________    periods of    ________    minutes each

            School concludes at      _________   pm

About your Ancient Day

The following information will be discussed with you to formulate a tailor-made Incursion for your school.

How much time do you have available for this incursion?             [   ] Full Day (9.00 – 3.30 approx) 

                                                                                                      [   ] Morning (9.00 – 1.00 approx) 

                                                                                                      [   ] Afternoon (11.00 – 3.30 approx)

Preferred Date/s:             ___________________________________________________________

Approx number of students that will participate:   __________    Number of classes:  ___________

Activities

We will work with you to ensure your activities are appropriate to your time and budget considerations, however, please indicate the sessions you might be interested in.  Keep in mind that a mix of Active (A) - all participate; Interactive (I)  - take turns; or Passive (P) - quieter sessions: avoids boredom or hyperactivity.  A detailed description of each activity is available on our website.

Preferred selection:      [   ]    Rulers & Subjects        (P)      

                                    [   ]    Sports & Status           (A)

                                    [   ]    Warriors & Warfare    (A)      

                                    [   ]     Ancient Metalworking  (I)       

                                    [   ]     Gladiators                    (I)                                 

                                    [   ]     Ancient China              (P)

                                    [   ]     Archery                       (A)      

                                    [   ]      Craft & Trade               (P)

                                    [   ]      Slavery                         (P)                                    

Will your staff be running any additional topics?

______________________________________________________________________________________

Some of our Presentations require the use of an Interactive Whiteboard.

Does your school have an Interactive Whiteboard available for our use?  _____________________

What sort? ____________________________   If not, is a data projector available? ____________

Do you use Easiteach software? ______________    (If no, we can load a Reader?)  ____________

Contact details for tech person: ____________________________________________________________

Medieval Education is now able to provide PD training and technical support for interactive technology.  Would your PD or Tech staff like to watch an Activity?             Yes / No

Would any of your staff be interested in a complimentary ‘Introduction to IWB’ session at the end of the days activities?                                                                                Yes / No

Contact details for PD person: _____________________________________________________________