Museum-on-the-Go Inquiry Form ORGANIZATION INFORMATIONSchool / Organization Name Name of facility where program will take place Address Street Address City State / Province / Region ZIP / Postal Code Contact Name Phone Email Address Best time to reach you?* DAY OF EVENT CONTACT INFORMATIONOnsite Coordinator Cell Phone Number Email Address PROGRAM INFORMATIONNumber of Students Up to 28 per classGrade Level / Age of Students Program Type Museum-on-the-Go Enrichment for Preschool Museum-on-the-Go Enrichment for Elementary Preschool Series: Little Explorers Elementary Series: Science Sleuths Memory Makers Adult/Child Programs Family Engagement Night Theme / Topic SCHEDULEPreferred Date Preferred Schedule Preschool Enrichments are approximately 45 minutes, Elementary Enrichments are approximately 60 minutes. Family Engagement Nights are 90 minutes.Presentation Type In-Person at your school / organization Online via Zoom For In-Person presentations: Where is the Educator to Go? (e.g. room number, gym, cafeteria) For In-Person presentations: Will the Educator stay in one room and have classes rotate in (most efficient) or travel from class to class? Stay in one room and have classes rotate in Travel from class to class PAYMENT INFORMATIONPayment will be made by Credit Card Purchase Order How did you hear about us?-- Select One --At MuseumImagine eNewsNewsletterProgram GuideSchoolIMAGINE CHILDREN'S MUSEUM MUSEUM-ON-THE-GO CONTRACTTo ensure a successful visit, please review and check each item below. Your online submission of this form constitutes your agreement to each of the following terms. If you have any questions, please email reservations@imaginecm.org, or call 425/258-1006, Ext. 1012 on weekdays from 9:00 a.m. - 5:00 p.m.Supervision* The classroom teacher is to remain with the students. For Family Engagement Nights, an Onsite Coordinator will be available throughout the event. Payment* Payment must be made in full and is non-refundable. Comments (special needs, etc.)Captcha