Challenger Learning Center Reservation Request Form

Reservation Request Form
Challenger Learning Center of the Capital Region
at miSci
Spring & Summer 2015
Complete this form and email to [email protected] or fax to 518-382-7893.
A reservationist will call you to book your trip.
Please let us know when to call you: date ________________ time ________________
Please note: Your mission is not booked until you receive a confirmation email from miSci.
GROUP INFORMATION
REQUESTED PROGRAMS
School / Organization Name
Program Date (please provide 3 choices)
________________________________________________
Teacher / Contact Name
1st choice
________________________________________________
Address_________________________________________
City_____________________________________________
State__________ Zip_______________________________
Phone (_____)____________________________________
Fax (____)________________________________________
District _________________________________________
County _________________________________________
E-mail Address ____________________________________
Grade / Age Level __________________________________
Number of Students _______ Number of Adults _______
(Maximum 30 students; at least 1 adult / every 6 students)
TEACHER MISSION PREP WORKSHOP (REQUIRED)
Prior to your mission, you will attend a Teacher Mission Prep
Workshop. Date will be coordinate when your reservation is
confirmed.
2nd choice
3rd choice
Mission / Time
Rendezvous with a Comet (Grades 5-12)
9 - 11:30am
12:30 - 3pm
Exploration Station (Grades 3 - 4)
9 - 10:30am
12 - 1:30pm
Cosmic Kids (Grades 1 - 2)
9 - 11am
12 - 2pm
Junior Astronauts (Grades preK - K)
Call for times
2 missions may be scheduled for 2 groups from your
school/organization sharing the same day.
Afterschool & Weekends available on request.
Additional Programs
Planetarium Show
Museum Time (self-guided)
Interactive Science Demo
Hands-on Science Exploration
Please note: miSci is an active science center. We strive to fulfill
our mission by serving people from throughout the region and beyond
every day; we may welcome multiple groups on your visit day.
miSci Promotional Photography Policy
By entering miSci’s facility and/or participating in a miSci activity or
event, you consent and authorize without restriction or compensation
to the possible use of your and your accompanying group’s image
appearing in photograph, audio, video, or other formats which may
be included in future media or marketing.
For miSci Use
Booked
Grant
Requesting Info
Check
Purchase Order
Initials
Cash