What you need: A classroom or open space 3 large tables or desks Access to a sink School or Organization Representative to remain onsite ORGANIZATION INFORMATIONSchool / Organization Name* Type of Organization** Please select one here *Church GroupClubs - Boys & Girls Clubs, YMCADaycare/Preschool/ChildcareHomeschoolLarge Groups - FamiliesMOPSSchool - ElementarySpecial Needs GroupName of facility where program will take place Address* Street Address City State / Province / Region ZIP / Postal Code Contact Name* Affiliation with the School / Organization i.e. teacher, principal ...Phone* Email Address* DAY OF EVENT CONTACT INFORMATIONOnsite Coordinator Cell Phone Number Cell phone is in case we need to reach you while enrouteEmail Address Best time to reach you?* PROGRAM INFORMATIONNumber of Students 20 students per class maxGrade Level / Age of Students After School SciencePlease select the topics that you are interested in:* Extreme Engineering Crazy Chemistry Number Quest Force Field Nature & Engineering Universal Marvels Epic Mashup Careers in Engineering Space Science for Fun Build It! In the Air Why did you choose this program?* Alignment with curriculum Just for fun Referred Are you new to us?* Yes No What you will need: A classroom or open space 3 large tables or desks Easy access to a sink Representative to remain on-site SCHEDULEStart Date End Date Occurence Weekly Bi-Weekly Day(s) of the Week Tuesday Wednesday Thursday Friday Include "Early Release Days" or "Holiday Weeks" Yes No Student Release Time Anticipated Program Start Time Session Time-frame 1-Hour Session 2-Hour Session PAYMENT INFORMATIONHow Program Will Be Funded? School District PTA Title 1 Other If other, please explain How did you hear about us?-- Select One --At MuseumImagine eNewsNewsletterProgram GuideSchoolTo be provided prior to the program start date Student Check-In & Check-Out Policy Class List with Emergency/Allergy Information Disciplinary Policy If Needed, Key Check-In & Check-Out Policy ** In order to reserve your program a non-refundable deposit will be required. IMAGINE 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. A 50% non-refundable deposit is required at scheduling; remaining balance is due day of services. * If using a Purchase Order the deposit is not required, but if the program is canceled or a "no show" you will be charged the deposit amount. Credit card information or Purchase Orders will need to be called in or faxed to the Museum by the date on the confirmation that you will receive. Please note: The Museum no longer accepts personal checks.Comments (special needs, etc.)Captcha
