What you need: A classroom or open space 3 large tables or desks School or Organization Representative to remain onsite ORGANIZATION INFORMATIONSchool / Organization NameName of facility where program will take placeAddress Street Address City State / Province / Region ZIP / Postal Code Contact NameAffiliation with the School / Organizationi.e. teacher, principal ...PhoneEmail AddressBest time to reach you?*DAY OF EVENT CONTACT INFORMATIONOnsite CoordinatorCell Phone NumberCell phone is in case we need to reach you while enrouteEmail AddressPROGRAM INFORMATIONNumber of Students20 students per class maxGrade Level / Age of StudentsLittle Science Lab program theme you are interested inAstonishing AirBeginning BotanistBlocks Measure UpBusy Buzzing BeesDiscovering ShellsFeathered FriendsMagnificent MagnetsRainy WeatherWater PlayWhat you will need: A classroom or open space 3 large tables or desks Representative to remain on-site SCHEDULEStart DateEnd DateOccurenceWeeklyBi-WeeklyDay(s) of the Week Tuesday Wednesday Thursday Friday Include "Early Release Days" or "Holiday Weeks"YesNoStudent Release TimeAnticipated Program Start TimeSession Time-frame1-Hour Session2-Hour SessionPAYMENT INFORMATIONHow Program Will Be Funded?School DistrictPTATitle 1OtherIf other, please explainHow 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
