PLC Visitation Form

Kildeer Countryside School District 96

PLC Visitation Registration Form
Meghan Bird, Director of Teaching and Learning
1050 Ivy Hall Lane Buffalo Grove, IL 60089
- Your reservation cannot be processed or confirmed without the submission of this form.
- Make a check payable to Kildeer Countryside School District 96 (Purchase orders and credit cards will not be accepted.)
- Payment is due one week prior to the date of visit.
- Do not make airfare or hotel reservations before receiving written confirmation of your scheduled data of visit and number of participants.
Name of visiting school and district*
Visiting school or district address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Visiting contact person*

First NameLast Name
Visiting contact phone*
Please enter a valid phone number.
Visitor contact email*
example@example.com

Site visit date requested for the 2025-2026 school year*
Check One:*

Elementary School PresentationMiddle School PresentationBoth Elementary and Middle School Presentations

Number of elementary school visitors*
Number of middle school visitors*
Total number of visitors
Total payment amount
Flat Rate: $500 for the first 10 visitors. Additional visitors beyond 10: $50 per person.
What PLC concept(s) would you like to make the focus of this visit?*
A confirmation email and invoice will be sent after your registration is reviewed.
Should be Empty: