Energy Heroes Booking Form Question Title * 1. Your name and school address Your name School name First line of address Post Code Email Address Phone Number Question Title * 2. What is your role in the school? Question Title * 3. Name and email address of Year 5 teachers Name Email Address Name Email Address Name Email address Question Title * 4. Name and email of Business Manager Name Email Address Question Title * 5. How many pupils do you have on roll in the whole school? Question Title * 6. How many year 5 pupils do you have? Question Title * 7. Who would you like the assembly delivered to? Whole school KS2 Question Title * 8. Please select up to 3 dates for the visit, numbering them 1, 2 and 3 in order of preference. If none are suitable, please suggest an alternative in the box provided. Tue 5th Nov Wed 27th Nov Wed 4th Dec Wed 11th Dec Tue 17th Dec Wed 18th Dec Alternative date (Tuesdays or Wednesdays only) from 15th January onwards Question Title * 9. When would you prefer your assembly and workshops to take place? NOTE: Please select 'Morning' if you have more than 1 year 5 class in order to fit in the year 5 workshops Morning Afternoon Question Title * 10. So we can schedule your visit:If you have chosen a morning visit, when is morning break time and when is KS2 lunch? Question Title * 11. If you have chosen an afternoon visit, when does lunch finish and is there an afternoon break for KS2? When does the teaching day end? Question Title * 12. Do you have an Eco Lead member of staff? If so please provide their email address Question Title * 13. Does your school have an Eco Club? Yes - Active Yes - Inactive No Question Title * 14. How did you hear about the Energy Heroes programme? Word of mouth Twitter Facebook Instagram LinkedIn Flyer Other Question Title * 15. If other, please specify Thank you very much for completing this expression of interest. A member of our team will be in touch shortly to confirm booking and offer dates for your first visit from the Energy Heroes! If you have any questions in the mean time, please drop us an email at hello@energyheroes.org.uk Done