Library Service Class Visit - Request Form

Name of School *

Please provide details of the School Contact

Title *

Title

Mrs

Miss

First Name

Surname *

Please provide the School Address

Address Line 1 *

Address Line 2

Address Line 3

Postcode *

Telephone Number

E-mail Address

Would you like a Librarian to visit your school?

Yes No

Would you like to arrange a visit to the Library?

Yes No

Please provide an approximate idea of the children's age and the number attending.

For mixed groups please use the 'ADD' button to enter the different details.

School Year

Foundation Age 3-5

Key Stage 1 Age 5-7

Key Stage 2 Age 7-11

Key Stage 3 Age 11-14

Key Stage 4 Age 14-16

Approximate number of children

What subjects would you like covering?

Request Date and Time for visit (Please allow a minimum of 3 weeks notice) *

Request Date and Time for visit (Please allow a minimum of 3 weeks notice)HoursMinutes
Month Day Year

Please provide at least one alternative date and time by using the 'ADD' button.

If you have any queries, please contact Sue Wink on telephone number 01472 323621 or by e-mail sue.wink@nelincs.gov.uk

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North East Lincolnshire Council, Municipal Offices, Town Hall Square, Grimsby, DN31 1HU, (01472) 313131

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