What you need: A classroom or open space 3 large tables or desks School or Organization Representative to remain onsite ORGANIZATION INFORMATIONSchool / Organization Name Name 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 Best time to reach you?* DAY OF EVENT CONTACT INFORMATIONOnsite Coordinator Cell Phone Number Cell phone is in case we need to reach you while enrouteEmail Address PROGRAM INFORMATIONNumber of Students 20 students per class maxGrade Level / Age of Students Little Science Lab program theme you are interested in Astonishing Air Beginning Botanist Blocks Measure Up Busy Buzzing Bees Discovering Shells Feathered Friends Magnificent Magnets Rainy Weather Water Play What you will need: A classroom or open space 3 large tables or desks 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
