ORGANIZATION INFORMATIONSchool / Organization Name* Type of Organization** Please select one here *Church GroupClubs - Boys & Girls Clubs, YMCADaycare/Preschool/ChildcareHomeschoolLarge Group - FamiliesLibraryMOPSSchool - ElementarySpecial Needs GroupPlease select oneName of facility where program will take place Address* Street Address City State / Province / Region ZIP / Postal Code Contact Name* 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 PROGRAM INFORMATIONApproximate Number of Participants Up to 250Grade Level / Age of Students Please select your program Adventures in Numberland Science Sensations Celebrate Our World Why did you choose this program?* Alignment with curriculum Just for fun Referred Are you new to us?* Yes No We supply Facilitator All supplies You supply Onsite coordinator Large multipurpose area 1 large table per activity / project 1 volunteer per activity / project Family Night programs have 10 activities. There must be one volunteer at each activitiy; the number of activities is dependent upon the number of volunteers during the program.SCHEDULEPreferred Date Preferred Time Program runs 90 minutesPAYMENT 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. A 50% non-refundable deposit is required at scheduling; remaining balance is due day of services. You will provide an onsite coordinator to assist in the set-up. Each activity/project will require the assistance of one volunteer. If required number of volunteers is not met, the number of activities/projects will decrease. You are still responsible for the balance due. A large table will be provided for each activity/project. Supplies will be available for the allotted amount of participants and the program will occur while supplies last. If the number of participants changes you must let the Museum know two weeks prior to event date. Comments (special needs, etc.)Captcha