Get Involved

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Table

Monday Tuesday Wednesday Thurday Friday Saturday Sunday
8am – 9pm 8am – 9pm 8am – 9pm 8am – 9pm 8am – 9pm 8am – 9pm 8am – 9pm

Embedded Map and Directions

From points east:
Take 66 West to exit 67 Left on Mall Blvd. Second right into parking lot.
Science center located near east enterance

From points west:
Take 66 Easy to exit 6 Left turn onto Lee Highway Left on Mall Blvd. Second right into parking lot.
Science center located near east enterance

Call to action

Section Title

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Event Type Icons

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  1. Parent's Contact Information
    • Name *
    • Email *
    • Phone Day *
    • Phone Evening/Weekend *
  2. What is your child's grade? * (If you have more than one child interested in classes, please fill out a separate form to reflect your preferences for each child.)
  3. Which time slot do you prefer for classes? * (Check all that apply)
     Monday early afternoon (1-4pm) Wednesday early afternoon (1-4pm) Monday late afternoon (4:30-6pm) Wednesday late afternoon (4:30-6pm) Saturday morning Saturday afternoon Sunday morning Sunday afternoon Other day/time not listed
  4. What length do you prefer? *
  5. What is your preferred session length assuming one class per week? *
  6. What class themes are you most interested in? * (check all that apply)  Simple Machines and Structures (Castles & Catapults) Science, Engineering, Mathematics and Inventing (Science Solutions) Structural Engineering Aeronautics and Flight Space Exploration Laws of Physics Environmental Protection Invention and Prototyping
  7. Please share any additional information or feedback.

2016-2017 Academic Year

Point of Contact First Name (required)

Point of Contact Last Name (required)

Point of Contact Title (required)

School (required)

Address (required)

City (required)

State (required)

Zip (required)

Telephone (required)

Email (required)

County (required)

Requested Dates:

Please list up to 6 dates in order of preference, on Fridays and Saturdays only, September through June. We will do our best to accommodate your first request.

Date 1

Date 2

Date 3

Date 4

Date 5

Date 6

Title I Schools: Please complete the specific Title I Family Science Night Application Form

** Please note that applications MUST be submitted with the knowledge and consent of the school!

Point of Contact First Name (required)

Point of Contact Last Name (required)

Point of Contact Title (required)

School/Organization (required)

Address (required)

City (required)

State (required)

Zip (required)

Telephone (required)

Email (required)

County (required)

Requested Dates: (required)
*At least 6 dates listed in order of preference, on Tuesdays and Thursdays only, September through April, is required. We will do our best to accommodate your first request.

Date 1

Date 2

Date 3

Date 4

Date 5

Date 6

Where will the event be held? e.g. gym, cafeteria, or multi-purpose room (required)

Submission of this form indicates that the school or organization agrees to the following obligations (please mark each box on the left of each item to signal understanding and compliance).

 I Agree to pay a flat fee of $600 to accommodate up to 350 visitors. Deposit of 20% ($120) is due at the time of scheduling your event date. The $480 balance is payable at the event.

 I Agree to provide 15 free-standing, 6-foot rectangular tables. I understand that cafeteria tables with attached seating or round tables are not permissible.

 I Agree to provide a minimum of 15 adult volunteers in a single shift to support the event between the hours of 5:00 – 8:30 p.m. Adult volunteers are considered 16 years or older. Due to liability restrictions, any volunteers younger than this minimum age requirement are not considered part of the minimum 15 volunteers requested and will not be assigned to an activity.

 I Understand that my volunteers must be on-site from 5:00 – 8:30 p.m. on the day of my scheduled event, and that splitting shifts between multiple groups of volunteers is disruptive to my event's logistics and will not be permitted.

 I Agree to provide volunteer contact information (names and email addresses, please) to the Children's Science Center NO LATER THAN 10 DAYS in advance of my scheduled event in order to ensure that each volunteer receives a station assignment and volunteer instruction packet in a timely manner. I agree not to make changes to these assignments without consulting the Children's Science Center first.

 I Understand that our school's volunteers must prepare in advance for the event by thoroughly reading the materials and viewing the related online video provided for their assigned activity, and should address any questions to the Children's Science Center well in advance of the event date as on-site training will not be readily available. I agree to reach out to the Children's Science Center in a timely fashion should I feel I need any assistance in preparing volunteers in advance of the event or desire to schedule a volunteer training session.

 I Agree to not permit food or beverages other than bottled water in the same room as the activities in order to prevent damage to the Center's materials and property.

 I Agree to provide the Children's Science Center access to the event space for 4 hours (5:00 – 9:00 pm).

 I Understand that Family Science Nights are only scheduled on Tuesdays and Thursdays from 6:00 – 8:00 p.m., September through April.

 I Consent to allow the Children's Science Center to take photos and/or video of my event, while respecting those students or parents who do not wish to have their photos or likenesses recorded.

 I Agree to provide a minimum of 8 weeks notice prior to canceling or requesting to reschedule an event. I understand that not all requests to reschedule an event can be accommodated.

 I Agree to publish two short articles in the school newsletter about the Children’s Science Center – one before Family Science Night and one after.

Failure to comply with these contractual obligations can lead to a forfeiting of your scheduled event, or ineligibility to participate in future events.

SPECIAL PROMOTION (OPTIONAL): The Children's Science Center Lab is offering a special promotion for schools who book a Spirit Night at the Lab for the 2016-2017 academic year. By indicating your willingness to plan a Spirit Night at the Lab below, your school will be entered in the priority blind drawing for Family Science Night! Spirit Nights are a new offering and a great way to continue the excitement for STEM learning in your school community as well as raise funds for your school.

Would you like to book a Spirit Night at the Children's Science Center Lab?

*If you selected yes, please also complete a Spirit Night Request form. Note that your school is not obligated to reserve a Spirit Night unless your application is selected in the Family Science Night drawing. If selected, your school must complete booking of both events to secure your selection. If not selected, you may still book a Sprit Night for your school at any time.

By submitting this form, the point of contact agrees to be the responsible party for the obligations outlined in this agreement. In this web form, your typed signature is treated by the Children's Science Center like a physical handwritten signature on a paper form.

Type Name of Responsible Party - will serve as your signature (required)

Date (required)


Application Form for 2016-2017 Academic Year

Point of Contact First Name (required)

Point of Contact Last Name (required)

Point of Contact Title (required)

School/Organization (required)

Street Address (required)

City (required)

State (required)

Zip (required)

County (required) Note: we follow your county's cancellation policies for inclement weather

Telephone (required)

Email (required)

Requested Dates (optional) Select 6 dates in order of preference, Mondays through Thursdays, Sept. through April; we will do our best to accommodate your first request. Dates are not required to apply for this program.

Is this a Title I school? (required)

Grade Level?

How many visits does your school's grade level require?

How many buses will your school require per visit, if necessary?


Submission of this form indicates that the school or organization agrees to the following (please mark each box on the left to each item to signal understanding and compliance)

 I Understand that only Title I schools in the Northern Virginia region are eligible to apply for the Discovery Days at the Lab program.

 I Agree to not permit food or beverages in the Lab.

 I Understand that Discovery Days at the Lab are only scheduled on Mondays through Thursdays from 10:00am – 12:00 pm or 12:00 – 2:00 pm, September through April.

 I Acknowledge that the Children's Science Center often uses photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media for promotional purposes. I hereby consent to the use of my group's name and/or likeness in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes. I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith. This consent is expressly intended to release the Children's Science Center from liability. Students or chaperones who do not wish to have their photos or likenesses recorded should notify the Children's Science Center when they arrive at the Lab.

 I Agree to provide a minimum of 8 weeks notice prior to cancelling or requesting to reschedule a visit. I understand that not all requests to reschedule a visit can be accommodated.

 I Agree to participate in one or more of the communications activities outlined in the program description.


FAILURE TO COMPLY WITH THESE CONTRACTUAL OBLIGATIONS CAN LEAD TO A FORFEITING OF YOUR SCHEDULED GROUP VISIT, OR INELIGIBILITY TO PARTICIPATE IN FUTURE EVENTS OR GROUP VISITS.


In this web form, your typed signature is treated by the Children's Science Center like a physical handwritten signature on a paper form.

Type Name of Responsible Party (will serve as your signature - required)

Date (required)