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. How many pupils do you have on roll in the whole school? Question Title * 4. Please suggest up to 3 dates (Tuesdays or Wednesdays) for the visit, in order of preference. First choice Second choice Third choice Question Title * 5. Who would you like the assembly delivered to? Whole school KS2 Question Title * 6. What time would you like the assembly to start? Question Title * 7. How many year 5 pupils do you have? Question Title * 8. Name and email address of Year 5 teachers Name Email Address Name Email Address Name Email address Question Title * 9. Does your school have an Eco Club? Yes - Active Yes - Inactive No Question Title * 10. Name and email of Business Manager Name Email Address Question Title * 11. How did you hear about the Energy Heroes programme? Word of mouth Twitter Facebook Instagram LinkedIn Flyer Other Question Title * 12. If other, please specify Done